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Xue P, Wang Z, Chai Y, Si M, Hu L. Treatment of congenital middle ear cholesteatoma in children using endoscopic and microscopic ear surgeries: a case series. Front Pediatr 2024; 12:1336183. [PMID: 38853779 PMCID: PMC11157046 DOI: 10.3389/fped.2024.1336183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Surgical removal is widely employed in children with congenital middle ear cholesteatoma (CMEC). Here, we report the surgical outcomes of CMEC removal via endoscopic ear surgery (EES) and microscopic ear surgery (MES) in children. Methods Children with CMEC who underwent preoperative medical history inquiry, hearing test, endoscopic evaluation, and radiology imaging before receiving EES or MES were included. Postoperative audiological outcomes and recurrence rates were collected. Results Seventeen children (20 ears) with stage II-IV CMEC were included. Of those, 11 ears (55.0%) underwent EES, and 9 ears (45.0%) underwent MES. The follow-up time was 35 ± 13.5 months. One child in the EES group with stage III CMEC had a recurrence during the follow-up period. In the EES group, the average minimum diameter of the external auditory canal on the affected side was 5.8 mm (4.3-8.0 mm). No linear association was found between age and the minimum diameter of the external auditory canal. Discussion EES is a promising treatment option for children with early-stage CMEC because of its low recurrence rate and minimally invasive nature. The minimum diameter of the external auditory canal on the affected side should be meticulously examined when performing EES in children.
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Affiliation(s)
- Po Xue
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Zhaoyan Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yongchuan Chai
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Mingjue Si
- Department of Radiology, Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingxiang Hu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
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Maccarrone F, Cantaffa C, Genovese M, Tassi S, Negri M. Fusion computed tomography-magnetic resonance imaging scans for pre-operative staging of congenital middle-ear cholesteatoma. J Laryngol Otol 2024; 138:507-511. [PMID: 37973528 PMCID: PMC11063661 DOI: 10.1017/s0022215123002001] [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: 09/12/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To evaluate if fusion computed tomography-diffusion-weighted magnetic resonance imaging may have a role in the pre-operative assessment of congenital middle-ear cholesteatoma. METHODS A retrospective chart review of surgically treated congenital middle-ear cholesteatoma patients over a 2-year timespan was conducted. Pre-operative staging was performed on computed tomography and fusion computed tomography-diffusion-weighted magnetic resonance imaging based on extension of the disease according to the ChOLE classification system and the Potsic classification system. Intra-operative staging was compared to imaging findings to evaluate accuracy of the two imaging modalities in predicting congenital middle-ear cholesteatoma extent. RESULTS Computed tomography was able to correctly predict congenital middle-ear cholesteatoma extent in three out of six cases according to the ChOLE classification system, all of which were staged as Ch1a and Ch1b on pre-operative computed tomography. Cases in which computed tomography was not able correctly to determine congenital middle-ear cholesteatoma extent were staged as Ch3 on pre-operative computed tomography. Fusion scans correctly determined congenital middle-ear cholesteatoma extent in all cases according to the ChOLE classification. CONCLUSIONS Fusion computed tomography-diffusion-weighted magnetic resonance imaging may be helpful in cases of congenital middle-ear cholesteatoma where pre-operative computed tomography shows mastoid and antrum opacification, in which computed tomography alone may overestimate cholesteatoma extension beyond the level of the lateral semi-circular canal.
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Affiliation(s)
- Francesco Maccarrone
- Department of Otolaryngology, Ospedale B Ramazzini di Carpi, AUSL Modena, Carpi, Italy
| | - Carla Cantaffa
- Department of Otolaryngology, Ospedale B Ramazzini di Carpi, AUSL Modena, Carpi, Italy
- Department of Otolaryngology – Head and Neck Surgery, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- University of Modena and Reggio Emilia / Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Maurilio Genovese
- Department of Neuroradiology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Sauro Tassi
- Department of Otolaryngology, Ospedale B Ramazzini di Carpi, AUSL Modena, Carpi, Italy
| | - Maurizio Negri
- Department of Otolaryngology, Ospedale B Ramazzini di Carpi, AUSL Modena, Carpi, Italy
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Fahy R, Corbett M, Crotty T, Chadwick L, Keogh I. Totally endoscopic cartilage tympanoplasty: a hierarchical task analysis. J Laryngol Otol 2023; 137:1326-1333. [PMID: 36093951 DOI: 10.1017/s0022215122001992] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Totally endoscopic ear surgery is a novel method of conducting otological surgery. Hierarchical task analysis and the systematic human error reduction and prediction approach ('SHERPA') are valuable tools that can effectively deconstruct the technical and non-technical skills required to successfully complete a surgical procedure. METHODS Twenty-five endoscopic tragal cartilage tympanoplasties were observed, to identify the tasks and subtasks required for completion of totally endoscopic tragal cartilage tympanoplasty. The systematic human error reduction and prediction approach was used to identify the potential risks and methods, to reduce or remediate these risks. RESULTS A hierarchical task analysis was performed, identifying 8 tasks and 50 subtasks for a safe approach to completing totally endoscopic tragal cartilage tympanoplasty. A risk score for each subtask was calculated to produce a systematic human error reduction and prediction approach and to highlight potential errors. CONCLUSION This hierarchical task analysis allowed for quick reference to a correct method of endoscopic tympanoplasty. The systematic human error reduction and prediction approach was employed to reduce the risks associated with undergoing endoscopic tympanoplasty, to improve patient safety.
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Affiliation(s)
- R Fahy
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - M Corbett
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - T Crotty
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - L Chadwick
- Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Ireland
| | - I Keogh
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
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Nassif N, Sorrentino T, Losito MT, Zorzi S, Redaelli de Zinis LO. Endoscopic transcanal tympanoplasty type I in children: Evolving experience in tragus perichondrium vs. acellular porcine small intestinal sub-mucosa grafts. Int J Pediatr Otorhinolaryngol 2022; 160:111245. [PMID: 35870255 DOI: 10.1016/j.ijporl.2022.111245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endoscopic trans-canal tympanoplasty type I (ETT) is gradually diffusing worldwide. It mainly allows less invasive surgery in children with respect to a microscope approach by avoiding post-auricular access. The aim of this study is to illustrate our experience in endoscopic reconstruction of tympanic membrane, using autologous tragus perichondrium (TP) and non-autologous acellular porcine small intestinal sub-mucosa (SIS) as grafts. METHODS Between January 2011 and December 2020, the results of a prospective non-randomized series of consecutive ETT were analyzed. The primary outcome was closure rate at 6 months and secondary outcomes are closure rates associated with age, size of perforation, type of perforation and middle ear status, presence of myringosclerosis, type of graft, status of contralateral ear, adenoidectomy and pre-postoperative ABG change. Statistical analysis was performed using the SPSS statistical package. RESULTS One hundred and sixteen consecutive procedures, mean age 9.4 years (range 4-17 years), were evaluated. TP and SIS grafts were used in 65 (56%) and 51 (44%) procedures, respectively. Mean duration of surgical procedure was 53 ± 21 min for SIS and 77 ± 18 min for TP (P = 0.001) Total graft intake was 82.8%; TP and SIS intake were 86.2% and 78.4% (P = 0.3), respectively. Graft intake w.r.t. in age stratified age groups was not statistically significant. Average preoperative and postoperative air-bone gap was 12.1 ± 7.6 dB and 5.5 ± 3.8 dB, respectively (P = 0.001). The difference in closure rates was not significant. Neither intra- nor postoperative complications were observed. CONCLUSIONS In children, ETT is an applicable and less invasive technique compared to the microscope and offers less morbidity. The use of SIS contributes additional less invasiveness to endoscopic surgery by avoiding tragus harvesting with a comparable success rate and granting significantly less surgical duration.
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Affiliation(s)
- Nader Nassif
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy.
| | - Tommaso Sorrentino
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Maria Teresa Losito
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Silvia Zorzi
- Department of Otolaryngology Head and Neck Surgery, "ASST Spedali Civili", Italy
| | - Luca Oscar Redaelli de Zinis
- Pediatric Otolaryngology Head Neck Surgery Division, Children Hospital "ASST Spedali Civili", Italy; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Bozzato A, Flockerzi V. [Endoscopically guided reconstruction of the ossicular chain-an introduction]. HNO 2021; 69:797-802. [PMID: 34125235 DOI: 10.1007/s00106-021-01062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
The term "endoscopic ossiculoplasty" refers to surgical methods with the intention to reconstruct the ossicular chain using endoscopic vision. Apart from malformations and injuries, inflammatory processes cause the majority of indications for ossicular reconstruction. This article offers a commented overview of current literature and preliminary personal experience.
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Affiliation(s)
- Alessandro Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland.
| | - Veronika Flockerzi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland
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Ito T, Furukawa T, Ohshima S, Takahashi K, Takata Y, Furukawa M, Hiraumi H, Yamauchi D, Yuasa Y, Goto S, Sasaki A, Koizumi K, Otsuki K, Imaizumi M. Multicenter Study of Congenital Middle Ear Anomalies. Report on 246 Ears. Laryngoscope 2021; 131:E2323-E2328. [PMID: 33645732 DOI: 10.1002/lary.29482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Congenital middle ear anomalies represent a relatively rare condition. This study aimed to describe the characteristics and the surgical outcomes for patients with middle ear anomalies. METHODS A multicenter study was conducted of consecutive patients with congenital middle ear anomalies who underwent primary surgical treatment between January 2008 and December 2017. Demographics, surgical procedures, and audiometric data were registered into the institutional database. Hearing changes and postoperative air-bone gap (ABG) were evaluated 1 year after surgery. RESULTS A total of 246 patients (246 ears) (median age: 14 years, range: 4-75 years old) were included in this study. Anomalies were subdivided using the Teunissen and Cremers classification: 53 ears (22%) were categorized as class I, comprising only stapes ankylosis; 35 ears (14%) as class II, having ossicular chain anomalies with stapes ankylosis; 139 ears (57%) as class III, having ossicular chain anomalies with a mobile stapes-footplate; and 19 ears (8%) as class IV, with aplasia of the oval window. Evaluation of hearing outcomes for 198 ears with more than 1 year of follow-up revealed that good postoperative ABG (≤20 dB) was achieved in 82% of class I, 68% of class II, 74% of class III, and 23% of class IV anomalies. The postoperative ABG in class IV was significantly worse than in class I (P < .001) or class III (P < .01). CONCLUSIONS This study demonstrated that class III anomalies comprised the majority of middle ear anomalies and surgical outcomes for class IV anomalies are unfavorable. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2323-E2328, 2021.
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Affiliation(s)
- Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayuki Furukawa
- Department of Otorhinolaryngology, Juntendo Urayasu Hospital, Chiba, Japan
| | - Harukazu Hiraumi
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, School of Medicine, Shiwa, Japan
| | - Daisuke Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Yuasa
- Sendai Ear Surgicenter, Sendai, Japan
| | - Shinichi Goto
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akira Sasaki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koh Koizumi
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Akita University, Akita, Japan
| | - Koshi Otsuki
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
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Salzman R, Bakaj T, Starek I. Postoperative pain and analgesic consumption after endoscopic and microscopic ear procedures. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:46-50. [PMID: 33542539 DOI: 10.5507/bp.2021.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Endoscopic ear surgery (EES) is considered a minimally invasive technique. It is hypothesized that patients after endoscopic procedures experience less pain and require fewer painkillers. Our aim was to compare patients' postoperative pain and need for analgesics in patients undergoing microscopic and endoscopic ear surgeries. METHODS a single-institution, prospective study included 92 patients undergoing ear procedures (48 cholesteatoma and 44 reconstructive);(43 endoscopic and 49 microscopic) during 1/2016-1/2018. The postoperative pain (visual analogue scale (VAS) 0-10) and painkillers consumption were recorded and compared in each subgroup. RESULTS VAS (P=0.02) and analgesics consumption (P=0.06) were lower after endoscopic ear surgeries. In the cholesteatoma group, 94% of endoscopic patients reported VAS 0-2 in contrast to 58 % of microscopic patients on day 1 (P=0.04). Similar tendencies were revealed in reconstructive cases, i.e. 92% compared to 73% (P>0.05). On day 1, 92% of endoscopic, and 77% of microscopic reconstruction patients received no painkillers group (P=0.06). In the cholesteatoma patients, 88% of endoscopic patients, 43% of microscopic patients using endaural approach, and 75% of microscopic patients using retroauricular approach, required no painkillers on the postoperative day 1 (P>0.05). CONCLUSIONS Our study revealed that the EES is associated with less postoperative pain than the conventional microscopic ear surgery. It seems that it is rather the transmeatal approach, and not the endoscope itself that reduces postoperative pain. The removal of the same size cholesteatoma using endoscope (rather than using microscope) leads to less intensive postoperative pain. Consequently, it was not surprising that patients after endoscopic ear surgery very rarely took painkillers.
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Affiliation(s)
- Richard Salzman
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Tomas Bakaj
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
| | - Ivo Starek
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic
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Abstract
Herein we provide a broad overview of the literature as it applies to endoscopic myringoplasty and type I tympanoplasty. Advantages and disadvantages of the endoscopic approach are reviewed for both the adult and pediatric populations and are compared with conventional microscopic techniques.
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Affiliation(s)
- Zachary G Schwam
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA.
| | - Maura K Cosetti
- Icahn School of Medicine of Mount Sinai, Department of Otolaryngology-Head and Neck Surgery, 1 Gustave L. Levy Place, Box 1189, New York, NY 10029, USA
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McCabe R, Lee DJ, Fina M. The Endoscopic Management of Congenital Cholesteatoma. Otolaryngol Clin North Am 2020; 54:111-123. [PMID: 33153732 DOI: 10.1016/j.otc.2020.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital cholesteatoma is a rare, primarily pediatric disease that presents in otherwise healthy ears. Typically, this disease is found in a well-defined sac in the middle ear, making it particularly suited for removal through transcanal endoscopic ear surgery. This article reviews the ways in which endoscopy can be applied to the surgical management of congenital cholesteatoma and provides a guide based on congenital cholesteatoma stage and extent. Outcomes have shown similar rates of residual disease in total endoscopic ear surgery compared with operative microscopy.
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Affiliation(s)
- Rachel McCabe
- Department of Otolaryngology, University of Minnesota, 420 Delaware Street Southeast, MMC 396, Minneapolis, MN 55455, USA
| | - Daniel J Lee
- Pediatric Otology and Neurotology, Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Manuela Fina
- Department of Otolaryngology, University of Minnesota, HealthPartners Medical Group, 401 Phalen Blvd, St Paul, MN 55130, USA.
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Total Endoscopic Ear Surgery in management of cochleocele: A case series. Int J Pediatr Otorhinolaryngol 2020; 135:110109. [PMID: 32480139 DOI: 10.1016/j.ijporl.2020.110109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
Abstract
Cochleocele is an extrusion or herniation of the endosteum, through an incomplete stapes footplate, into the middle ear. The cochleocele may rupture resulting in a cerebrospinal fluid leak into the middle ear space causing a risk of menigitis. We report six cases of Incomplete Partition Type I with cochleocele which have all been successfully treated using a Totally Endoscopic Ear Surgery approach even during infancy. As the first two cases developed post-operative pseudomonas meningitis, preventative strategies are recommended.
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Measurement of the Pediatric and Adult Osseous External Auditory Canal: Implications for Transcanal Endoscopic Ear Surgery. Otol Neurotol 2020; 41:e712-e719. [DOI: 10.1097/mao.0000000000002653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Use of the KTP laser in totally endoscopic cholesteatoma surgery. The Journal of Laryngology & Otology 2020; 134:362-365. [PMID: 32122410 DOI: 10.1017/s0022215120000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This paper reviews our experience of potassium titanyl phosphate (KTP) laser in transcanal totally endoscopic cholesteatoma surgery. METHODS A prospective cohort study was conducted in a tertiary referral centre, involving a consecutive series of children with cholesteatoma who underwent totally endoscopic cholesteatoma surgery with a KTP laser. RESULTS The patients' mean age was 10.5 years (range, 1.8-18 years). A KTP laser was used in 70 of the 83 cases (84 per cent). The laser was not used in 13 'clean' cases, in which disease was removed more easily. Residual disease was detected in five cases (6 per cent), of which the KTP laser had been used in four (5 per cent). No complications were associated with KTP laser use. CONCLUSION The combination of KTP laser use with endoscopic visualisation is effective for minimising the risk of residual disease using a minimally invasive surgical approach. The thin, semi-flexible fibre carrier of the KTP laser is ideally suited to work alongside the endoscope within the narrow confines of the ear canal.
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Bartel R, Cruellas F, Hamdan M, Benjumea F, Huguet G, Gonzalez-Compta X, Cisa E, Manos M. Endoscopic type 3 tympanoplasty: Functional outcomes in chronic otitis media. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miller KA, Fina M, Lee DJ. Principles of Pediatric Endoscopic Ear Surgery. Otolaryngol Clin North Am 2019; 52:825-845. [DOI: 10.1016/j.otc.2019.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Luu K, Chi D, Kiyosaki KK, Chang KW. Updates in Pediatric Cholesteatoma. Otolaryngol Clin North Am 2019; 52:813-823. [DOI: 10.1016/j.otc.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bartel R, Cruellas F, Hamdan M, Benjumea F, Huguet G, Gonzalez-Compta X, Cisa E, Manos M. Endoscopic type 3 tympanoplasty: Functional outcomes in chronic otitis media. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:83-87. [PMID: 31383353 DOI: 10.1016/j.otorri.2019.02.001] [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: 08/17/2018] [Revised: 02/03/2019] [Accepted: 02/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Type 3 tympanoplasty is the surgery of choice for middle ear reconstruction in cases where an integral stapes suprastructure and mobile footplate are present. OBJECTIVE The objective of this study was to obtain functional results after endoscopic type 3 tympanoplasty in chronic otitis media. MATERIALS AND METHODS Prospective study including 24 patients who underwent endoscopic type 3 tympanoplasty, using PORP for ossicular chain reconstruction (OCR) and cartilage graft for tympanic membrane reconstruction. Audiograms were made preoperatively, and 6 months after surgery. RESULTS Dry, closed, self-cleaning ears were obtained in 91.7% of the cases. Mean preoperative air-bone gap (ABG) was 30.4dB, mean postoperative ABG was 16.7dB, dB gain of 13.6dB. ABG closure rate to 20dB or less of 79.2%, and to 10dB or less of 29.2%. CONCLUSION AND SIGNIFICANCE Endoscopic tympanoplasty and OCR is a valid option for surgeons who are comfortable with the use of endoscopes for middle ear surgery as it allows improved visualization of the prosthesis and graft placement during middle ear reconstruction.
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Affiliation(s)
- Ricardo Bartel
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
| | - Francesc Cruellas
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Miriam Hamdan
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Felipe Benjumea
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Gabriel Huguet
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Xavier Gonzalez-Compta
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Enric Cisa
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Manel Manos
- Otolaryngology Department, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
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Transcanal endoscopic type 1 tympanoplasty in children: Cartilage butterfly and fascia temporalis graft. Int J Pediatr Otorhinolaryngol 2019; 121:120-122. [PMID: 30884342 DOI: 10.1016/j.ijporl.2019.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Endoscopic type 1 tympanoplasty is every day gaining numerous adepts for tympanic membrane repair. Due to the value of reducing postauricular approaches, decreasing postoperative morbidity and hospitalization time. The objective of this study is to present surgical results of endoscopic type 1 tympanoplasty in the pediatric population using fascia temporalis or cartilage butterfly graft. MATERIALS AND METHODS Prospective study regarding the pediatric population, mean age of 10.7 years old. Patients diagnosed with chronic otitis media without cholesteatoma and intact ossicular chain. Tympanic membrane reconstruction using inlay cartilage butterfly graft or underlay fascia temporalis graft according to surgical needs. Audiograms were evaluated preoperatively and 6 months after surgery. No postauricular approaches were performed. RESULTS A total of 54 ears were operated, 25 utilizing underlay fascia temporalis graft and 29 using inlay cartilage butterfly graft. Six months following surgery, dry and closed tympanic membranes were obtained in 54 cases (92.6%). Preoperative and postoperative air conduction (AC) thresholds, bone conduction (BC) thresholds and air-bone gaps (ABG) were assessed. Preoperative AC of 24.6 dB, BC of 8.9 dB and an ABG of 15.5 dB. Postoperative AC of 16.3 dB, BC of 8.9 and an ABG of 6.9 dB. A postoperative ABG reduction of 8.5 dB was reached. CONCLUSION Transcanal endoscopic type 1 tympanoplasty can be achieved in every pediatric patient with chronic otitis media without cholesteatoma, and, is a safe and efficient procedure.
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Li B, Asche S, Yang R, Yueh B, Fina M. Outcomes of Adopting Endoscopic Tympanoplasty in an Academic Teaching Hospital. Ann Otol Rhinol Laryngol 2019; 128:548-555. [DOI: 10.1177/0003489419830424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To compare the outcomes of endoscopic versus microscopic tympanoplasty during the initial period of a surgeon adopting the new endoscopic technique and teaching the surgical approach to residents assisting in surgery. Methods: Retrospective medical chart review of 60 consecutive operations for repair of isolated tympanic membrane perforations from 2011 to 2016 performed by a single surgeon assisted by residents in an academic teaching hospital. The outcomes of 20 ears repaired microscopically before the senior author adopted endoscopic ear surgery (Group A) were compared with the outcomes of the first 20 ears that were attempted with endoscopic surgery (Group B) and the next 20 ears performed endoscopically (Group C). Sixty ear operations were performed on 52 patients as 8 patients had bilateral ear surgery. Results: The tympanic membrane closure rate was 80% for Group A, 80% for Group B, and 95% for Group C. Mean air-bone gap improvement was 12.8 dB in Group A, 8.3 dB in Group B, and 12.1 dB in Group C. Mean duration of surgery was 99.2 minutes in Group A, 91.3 minutes in Group B, and 90.5 minutes in Group C. In Group B, 20% of the ears (4/20) were converted to a microscopic approach; in Group C, none required conversion. Conclusions: Maintenance of good outcomes and similar results can be maintained during a surgeon’s transition to adopting endoscopic tympanoplasty and teaching it to residents.
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Affiliation(s)
- Bin Li
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Stephen Asche
- Health Partners Medical Group, Bloomington, Minnesota, USA
| | - Robert Yang
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Bevan Yueh
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Manuela Fina
- University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
- Health Partners Medical Group, Bloomington, Minnesota, USA
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Rusetsky YY, Meitel IY, Sotnikova LS, Malyavina US, Kalugina MS. [Prospects of endoscopic otosurgery in children]. Vestn Otorinolaringol 2019; 84:5-11. [PMID: 31486419 DOI: 10.17116/otorino2019840315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Active progress in otosurgery opens up new opportunities for minimally invasive surgeries and significantly improves the results of treatment, but a number of problems remain unsolved, including in children. Despite the general positive trend of using the endoscope in otosurgery, in pediatric practice the data are insufficient and extremely contradictory. Literary sources show that, with certain advantages, the existing techniques of endoscopic tympanoplasty are far from perfect and inferior in effectiveness to classical microscopic techniques, which also necessitates further research in this field.
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Affiliation(s)
- Yu Yu Rusetsky
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - I Yu Meitel
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - L S Sotnikova
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - U S Malyavina
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
| | - M S Kalugina
- National medical research center for children's health of the Ministry of health of Russia, Moscow, Russia, 119991
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Ryan PJ, Patel NP. Endoscopic Management of Pediatric Cholesteatoma. J Otol 2018; 15:17-26. [PMID: 32110236 PMCID: PMC7033597 DOI: 10.1016/j.joto.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Pediatric cholesteatoma occurs in one of two forms: congenital cholesteatoma, developing from embryonic epidermal cell rests or acquired cholesteatoma, associated with a focal defect in the tympanic membrane. This disease has been traditionally managed with the operating microscope, often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities. Recently, advances in endoscopic equipment have enabled otologists to manage most cases of pediatric cholesteatoma via a minimally-invasive, transcanal endoscopic approach. This review discusses the current literature relating to the etiopathogenesis, assessment and endoscopic management of pediatric cholesteatoma. Early outcomes of endoscopic treatment, emerging trends and technologies are also reviewed.
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Affiliation(s)
- Peter J Ryan
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nirmal P Patel
- Department of Otolaryngology and Head and Neck Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.,Kolling Deafness Research Centre, Macquarie University and University of Sydney, NSW, Australia
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The Current Limitations and Future Direction of Instrument Design for Totally Endoscopic Ear Surgery: a Needs Analysis Survey. Otol Neurotol 2018; 39:778-784. [DOI: 10.1097/mao.0000000000001802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kul'makov SA, Polunin MM, Soldatsky YL, Ivanenko AM. [The role of the endoscopic assistance in the surgical treatment of the children presenting with chronic suppurative otitis media and cholesteatoma]. Vestn Otorinolaringol 2018; 83:16-19. [PMID: 29953048 DOI: 10.17116/otorino201883316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The present study was designed to elucidate the possibilities for the application of angled endoscopes in the sanation of those compartments of the middle ear which are difficult to access for visual control with the use of a microscope, such as the retrotympanic structures (e.g. tympanic and facial retraction pockets), anterior epitympanum, etc. To this effect, we have undertaken the analysis of the results of surgical interventions on the children presenting with chronic suppurative otitis media and concomitant cholesteatoma. A total of 59 primary operations and 35 secondary ones were performed to treat recurrent cholesteatoma. In 41 cases, the surgical intervention was carried out without the endoscopic assistance whereas in the remaining 53 ones the microscopic observation of the difficult-to-access compartments of the middle ear were supplemented by the application of an angled endoscope. Whenever residual portions of cholesteatoma were identified, they were removed under the endoscopic control. The algorithm for the endoscopic assistance during such operations has been proposed, its advantages and limitations are considered. It is concluded that the combination of microscopic and endoscopic techniques for the examination of and operation on the middle ear creates the conditions for the more reliable (in comparison with the traditional otomicroscopic methods) removal of the residual cholesteatoma tissues and thereby allows to reduces the risk of development of residual cholesteatoma from 25% to 13.5%. The results of the present study have demonstrated the necessity of development of a universal approach to the identification of the clinically significant manifestations of chronic suppurative otitis media and cholesteatoma.
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Affiliation(s)
- S A Kul'makov
- N.I. Pirogov Russian National Research Medical University, Department of Otorhinolaryngology Ministry of Health of the Russian Federation, Moscow, Russia, 117997; Morozovskaya City Children's Clinical Hospital, Moscow Health Department, Moscow, Russia, 111049
| | - M M Polunin
- N.I. Pirogov Russian National Research Medical University, Department of Otorhinolaryngology Ministry of Health of the Russian Federation, Moscow, Russia, 117997
| | - Yu L Soldatsky
- N.I. Pirogov Russian National Research Medical University, Department of Otorhinolaryngology Ministry of Health of the Russian Federation, Moscow, Russia, 117997; Morozovskaya City Children's Clinical Hospital, Moscow Health Department, Moscow, Russia, 111049
| | - A M Ivanenko
- Morozovskaya City Children's Clinical Hospital, Moscow Health Department, Moscow, Russia, 111049
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Park JH, Ahn J, Moon IJ. Transcanal Endoscopic Ear Surgery for Congenital Cholesteatoma. Clin Exp Otorhinolaryngol 2018; 11:233-241. [PMID: 29940721 PMCID: PMC6222188 DOI: 10.21053/ceo.2018.00122] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/20/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives As endoscopic instrumentation, techniques and knowledges have significantly improved recently, endoscopic ear surgery has become increasingly popular. Transcanal endoscopic ear surgery (TEES) can provide better visualization of hidden areas in the middle ear cavity during congenital cholesteatoma removal. We aimed to describe outcomes for TEES for congenital cholesteatoma in a pediatric population. Methods Twenty-five children (age, 17 months to 9 years) with congenital cholesteatoma confined to the middle ear underwent TEES by an experienced surgeon; 13 children had been classified as Potsic stage I, seven as stage II, and five as stage III. The mean follow-up period was 24 months. Recurrence of congenital cholesteatoma and surgical complication was observed. Results Congenital cholesteatoma can be removed successfully via transcanal endoscopic approach in all patients, and no surgical complications occurred; only one patient with a stage II cholesteatoma showed recurrence during the follow-up visit, and the patient underwent revision surgery. The other patients underwent one-stage operations and showed no cholesteatoma recurrence at their last visits. Two patients underwent second-stage ossicular reconstruction. Conclusion Although the follow-up period and number of patients were limited, pediatric congenital cholesteatoma limited to the middle ear cavity could be safely and effectively removed using TEES.
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Affiliation(s)
- Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jungmin Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Endoscopic visualization to the anterior surface of the malleus and tensor tympani tendon in congenital cholesteatoma. Eur Arch Otorhinolaryngol 2018; 275:1069-1075. [PMID: 29508055 DOI: 10.1007/s00405-018-4917-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study evaluated the feasibility of endoscopy in exposing the anterior surface of the malleus and tensor tympani tendon (ASMT) in children with congenital cholesteatoma (CC), and investigated the outcomes of hearing, postoperative complications, and residual or recurrent disease in endoscopic surgical approach cases. METHODS A retrospective case review was performed in one tertiary referral center. Twelve children with CC involving the ASMT were recruited, and their medical records were reviewed. All patients underwent either total endoscopic surgery (n = 3) or endoscope-assisted surgery (n = 9), and Potsic staging was adopted to classify CC according to its severity: stage I (n = 8), stage II (n = 2), and stage III (n = 2). The mean follow-up period was 15.5 ± 2.8 months. The visibility of the ASMT by endoscope assistance, audiological results, surgical and postoperative complications, and recidivism of CC were analyzed. RESULTS The ASMT was well visualized by endoscope assistance in all cases. No patient showed hearing deterioration at 3 months after surgery, and none experienced residual or recurrent disease during the follow-up period. Postoperative complications were not observed. CONCLUSIONS Total endoscopic or endoscope-assisted surgery could help surgeons directly visualize the ASMT in children, with negligible risks of hearing deterioration, postoperative complications, and recurrent disease. Our study might suggest that endoscopic ear surgery should be considered in patients with CC in the ASMT.
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Farinetti A, Farah C, Triglia JM. Myringoplasty in Children for Tympanic Membrane Perforation: Indications, Techniques, Results, Pre- and Post-Operative Care, and Prognostic Factors. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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James AL. Cholesteatoma in Children: Surgical Technique, Hearing Rehabilitation and Surveillance. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0180-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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29
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Sun WH, Kuo CL, Huang TC. The anatomic applicability of transcanal endoscopic ear surgery in children. Int J Pediatr Otorhinolaryngol 2018; 105:118-122. [PMID: 29447797 DOI: 10.1016/j.ijporl.2017.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The feasibility of TEES in dealing with pediatric middle ear disease is still under investigation. The goal of this study was to compare anatomical dimensions of the EAC between children and adults, and to analyze the anatomic applicability of TEES in children. METHODS Forty pediatric (18 years old and younger) and 20 adult patients who received TB-HRCT to evaluate middle ear conditions were enrolled from December 2010 to December 2015. Dimensions including the diameters of the EAC orifice, isthmus and tympanic membrane annulus, the length of EAC, the height of the middle ear, and the angle between tympanic membrane and EAC axis were determined according to the TB-HRCT data. RESULTS The diameters of the EAC orifice and isthmus and length of EAC in the pediatric patients were slightly smaller than those in the adult patients. The anatomical dimensions of middle ear were similar in both groups. Simple regression analysis indicated that the diameters of the EAC orifice and isthmus and the length of the EAC were positively correlated with the age of the pediatric patients. In the pediatric patients, 67 ears (83.75%) had an EAC isthmus diameter larger than 4 mm and are sufficient with a 3-mm endoscope manipulation. CONCLUSION TEES is applicable for most pediatric patients using an endoscope with a diameter of 3 mm or smaller. With an appropriate endoscope and instruments, TEES is a safe and effective alternative to treat pediatric middle ear disease.
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Affiliation(s)
- Wan-Hsuan Sun
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
| | - Chin-Lung Kuo
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taiwan
| | - Tzu-Chin Huang
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan.
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30
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Magliulo G, Iannella G. Endoscopic versus microscopic approach in attic cholesteatoma surgery. Am J Otolaryngol 2018; 39:25-30. [PMID: 29037582 DOI: 10.1016/j.amjoto.2017.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/22/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Compare the outcomes of primary exclusive endoscopic ear surgery with those of the microscopic ear surgery in a group of patients affected by attic cholesteatoma. MATERIALS AND METHODS Eighty patients suffered from attic cholesteatoma. Forty patients surgical treated with endoscopic ear surgery and forty patients surgical treated with microscopic ear surgery. RESULTS No statistical differences were found in the parameters analysed (frequency of facial nerve dehiscence, age, disease duration, site of dehiscence) between the endoscopic and microscopic groups indicating a homogeneous selection thus providing a good comparison of the outcomes between the two groups. None of the patients in our survey developed postoperative iatrogenic facial palsy. Graft success rate was 100% in both groups. The overall operation time of endoscopic ear surgery presented a mean value of 87.8min, while in the group of patients treated via microscopic ear surgery a lower mean value of 69.9min was reported. The average healing time was 36.3days for the endoscopic subgroup and 47.8days for the microscopic subgroup. CONCLUSION The surgical outcomes of endoscopic ear surgery are comparable to those of the conventional approach in terms postoperative air-conduction, graft success rate and taste sensation. The analysis of postoperative pain and healing times showed better results for EES. The mean operative times of endoscopic ear surgery gradually shortened as the surgeons gained expertise in performing one-hand surgery.
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Marchioni D, Rubini A, Gonzalez-Navarro M, Alicandri-Ciufelli M, James A, Presutti L. Bilateral congenital cholesteatoma: Surgical treatment and considerations. Int J Pediatr Otorhinolaryngol 2017; 99:146-151. [PMID: 28688558 DOI: 10.1016/j.ijporl.2017.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/03/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To describe a multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition. In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain. STUDY DESIGN Retrospective chart and surgical video review of patients with BCC who underwent surgery at Otolaryngology Department of Modena and Verona University Hospitals and the Hospital for Sick Children, Toronto. METHODS From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described. RESULTS The median age at presentation was 4 years (range 2-7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months. CONCLUSIONS When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.
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Affiliation(s)
- Daniele Marchioni
- Department of Otolaryngology - Head & Neck Surgery, University of Verona, Piazzale Aristide Stefani, 1 37126 Verona, Italy
| | - Alessia Rubini
- Department of Otolaryngology - Head & Neck Surgery, University of Verona, Piazzale Aristide Stefani, 1 37126 Verona, Italy.
| | - Mauricio Gonzalez-Navarro
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Matteo Alicandri-Ciufelli
- Department of Otolaryngology - Head & Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Adrian James
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Hospital for Sick Children, 555 University Avenue, Toronto, Canada
| | - Livio Presutti
- Department of Otolaryngology - Head & Neck Surgery, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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In response to Letter to the Editor entitled "It is prudent to consider use of endoscopic tympanoplasty to treat complicated middle ear disease". Eur Arch Otorhinolaryngol 2017; 274:4067-4068. [PMID: 28653268 DOI: 10.1007/s00405-017-4654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Ghadersohi S, Carter JM, Hoff SR. Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma. Laryngoscope 2017; 127:2653-2658. [DOI: 10.1002/lary.26654] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/27/2017] [Accepted: 03/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University Feinberg School of Medicine
| | - John M. Carter
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois U.S.A
| | - Stephen R. Hoff
- Department of Otolaryngology-Head and Neck Surgery; Northwestern University Feinberg School of Medicine
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago Illinois U.S.A
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Carter JM, Hoff SR. Endoscopic middle ear exploration in pediatric patients with conductive hearing loss. Int J Pediatr Otorhinolaryngol 2017; 96:21-24. [PMID: 28390607 DOI: 10.1016/j.ijporl.2017.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe our indications, findings, and outcomes for transcanal endoscopic middle ear exploration in pediatric patients with conductive hearing loss of unknown etiology, without effusions. METHODS Prospective case series for all pediatric patients undergoing totally endoscopic transcanal middle ear exploration between April 2012 and October 2015 at a pediatric tertiary care referral hospital. Demographic data, operative findings, and hearing results were reviewed. RESULTS 21 cases were performed in 20 ears (1 revision). Average age at surgery was 7.98 years and average follow up was 2.1 years. Middle ear pathology identified on CT imaging was confirmed in 55% of cases while identified in 45% of cases where pre-operative imaging was non-diagnostic. 6/20 patients (30%) had an ossicular deformity. 8/20(40%) had bony ossicular fixation. 5/20(25%) had ossicular discontinuity. 2/20(10%) had facial nerve dehiscence impinging on the stapes. 15% had adhesive myringosclerosis or severe granulation causing hearing loss. Prosthetic ossiculoplasty was done in 7/21 (33.3%) of the cases, with 1 TORP, 3 PORPs, and 3 IS joint replacements. Imaging was predictive of intra-operative findings in 13/20 cases (55%). Trainees assisted in 16/21(76%) of cases. The average improvement of PTA was 11.65 dB (range -10 to 36.25), and the average ABG improved 10.19 (range -11.25 to 28.75). There were no perioperative complications or adverse events. CONCLUSIONS The endoscopic transcanal approach for middle ear exploration offers excellent visualization and is one of the best applications for the endoscopes in pediatric otology cases. This is particularly helpful for "unexplained" conductive hearing loss where ossicular deformity/fixation/discontinuity is suspected. The etiology of the conductive hearing loss was definitively found in 100% of cases, and can be repaired in the same sitting when applicable.
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Affiliation(s)
- John M Carter
- Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, United States.
| | - Stephen R Hoff
- Anne & Robert H. Lurie Children's Hospital of Chicago, 225 Chicago Ave, Chicago, IL, 60611, United States; McGaw Medical Center of Northwestern University, 240 East Huron Street, Chicago, IL, 60611, United States.
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De Zinis LOR, Berlucchi M, Nassif N. Double-handed endoscopic myringoplasty with a holding system in children: Preliminary observations. Int J Pediatr Otorhinolaryngol 2017; 96:127-130. [PMID: 28390601 DOI: 10.1016/j.ijporl.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Endoscopic transcanal myringoplasty is a newly-introduced technique for reconstruction of tympanic membrane perforation that offers the advantage to obviate postauricular incision. The objective of this study was to evaluate the feasibility of a double-handed endoscope holder transcanal myringoplasty in children. This technique permits bimanual execution of the procedure and allows the surgeon to overcome the two significant issues of single-handed endoscope surgery, i.e. easy domination of a bloody field and smooth introduction of the graft. METHODS A prospective non-randomized study of 10 consecutive primary endoscope holder-aided myringoplasties was performed; 3 mm or 4 mm 0° rigid endoscopes were used. A xenograft, biologic soft tissue, was applied in all cases. RESULTS All procedures were performed successfully. Duration of surgery was faster than with a single-handed procedure and varied between 20 and 60 min. The tympanic membrane healed successfully in all patients. CONCLUSIONS In this preliminary experience in children, a bimanual endoscopic holder-aided myringoplasty technique offers the possibility to overcome the obstacles encountered in a single-handed technique, since it can replicate the same concept of a bimanual microscopic approach and allow for easy management of a bloody field and introduction of the graft in the middle ear.
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Affiliation(s)
| | - M Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
| | - N Nassif
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy.
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36
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James AL. Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome. Laryngoscope 2017; 127:2659-2664. [DOI: 10.1002/lary.26568] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/08/2017] [Accepted: 02/09/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Adrian L. James
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, Hospital for Sick Children; Toronto Ontario Canada
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Salisu AD, Jibril YN. Extending otology services to rural settings: Value of endoscopic ear surgery. Ann Afr Med 2017; 15:104-8. [PMID: 27549413 PMCID: PMC5402810 DOI: 10.4103/1596-3519.188888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Few centers, mainly located in urban settings offer otological surgical services, yet majority of patients requiring these services are rural based and are generally unable to access these centers with resulting disease chronicity and complications. This paper aims to describe the access of otological surgical services by a rural population. Methodology: This is a retrospective study of patients who accessed otological services at three secondary health institutions and one tertiary referral institution. All patients requiring ear surgery over a 4-year period were studied. The initial 2 years without ear endoscopic surgery was compared with the 2 years when ear endoscopic surgery was introduced. Hospital records were studied and relevant data were extracted. Results: Six hundred and nine ears required surgery over 4 years. Age ranged from 3 to 62 years, with a ratio of 1.4 males: 1 female. During the initial 2 years, all patients were referred from the three secondary health institutions to the urban-based tertiary institution for microscopic ear surgery, 94% failed to proceed on the referral. In the second 2 years, 34% were considered suitable for endoscopic ear surgery, of which 78% accepted and had surgery within the locality. Of the 66% referred, only 5% proceeded on the referral. Conclusion: With operator training and investment in portable ear endoscopy set, bulk of ear surgery needing magnification can be treated in the rural setting. This represents a most feasible means of extending the service to the targeted population.
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Affiliation(s)
- Abubakar Danjuma Salisu
- Department of Otolaryngology (ENT), Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
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Abstract
OBJECTIVE Endoscopes can facilitate surgery within tympanomastoid recesses that are not visible with the operating microscope. This study investigates whether use of endoscopes to guide dissection of cholesteatoma leads to lower rates of residual cholesteatoma than using the endoscope only for inspection after microscope-guided dissection. STUDY DESIGN Comparative cohort study. SETTING Tertiary pediatric center. PATIENTS Two hundred thirty-five patients with acquired or congenital cholesteatoma in children <18 years having intact canal wall surgery and follow-up >12 months. INTERVENTIONS Comparison of group (A) microscope surgery followed by endoscopic inspection, with group (B) endoscope-guided dissection. MAIN OUTCOME MEASURES Residual cholesteatoma rates, controlling for site of initial cholesteatoma, detection by second-stage surgery, and length of follow-up. RESULTS Analysis of all patients showed endoscopic dissection was associated with less residua in the middle ear (risk difference = 0.12; p = 0.026, Kaplan-Meier log rank analysis; number needed to treat = 9) but not at other sites. When restricting analysis to ears that were evaluated with second look surgery, no significant reduction in residual disease was found after endoscopic dissection at any site (e.g., retrotympanic residua: 12% Group A versus 7% Group B (NS, Fisher exact test). Endoscopic dissection allowed more permeatal surgery. No complications were attributable to endoscope use. Wound complications occurred in 4% of open cases. CONCLUSION Endoscopes enhance surgical access to tympanomastoid recesses. In conjunction with the availability of the operating microscope, angled instruments, and KTP laser, endoscope-guided dissection provides a small incremental benefit for prevention of residual cholesteatoma, and facilitates a minimally invasive approach.
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Yong M, Mijovic T, Lea J. Endoscopic ear surgery in Canada: a cross-sectional study. J Otolaryngol Head Neck Surg 2016; 45:4. [PMID: 26786729 PMCID: PMC4717547 DOI: 10.1186/s40463-016-0117-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Endoscopic ear surgery is an emerging technique with recent literature highlighting advantages over the traditional microscopic approach. This study aims to characterize the current status of endoscopic ear surgery in Canada and better understand the beliefs and concerns of the otolaryngology – head & neck surgery community regarding this technique. Methods A cross-sectional survey study of Canadian otolaryngologists was performed. Members of the Canadian Society of Otolaryngology were contacted though an online survey carried out in 2015. Results The majority of participants in this study (70 %) used an endoscope in their practice, with a large proportion utilizing the endoscope for cholesteatoma or tympanoplasty surgery. To date, 38 Canadian otolaryngologists (70 % of respondents) have used an endoscope for at least 1 surgical case, but only 6 (11 %) have performed more than 50 endoscopic cases. Of the otolaryngologists who use endoscopes regularly, the majority still use the microscope as their primary instrument and use the endoscope only as an adjunct during surgery. However, the general attitude surrounding endoscopes is positive; 81 % believe that endoscopes have a role to play in the future of ear surgery and 53 % indicated they were likely to use endoscopes in their future practice. Participants who were earlier in their practice or who had more exposure to endoscopic techniques in their career were more likely to have a positive stance towards endoscopic ear surgery (p < 0.05, p < 0.01, respectively). The main concern regarding endoscopic ear surgery was the technical challenge of one-handed surgery, while the primary perceived advantage was the reduced rates of residual or recurrent disease. Conclusions Endoscopic ear surgery is a new technique that is gaining momentum in Canada and there is enthusiasm for its incorporation into future practice. Further investment in training courses and guidance for those looking to start or advance the use of endoscopes in their practice will be vital in the years to come. Electronic supplementary material The online version of this article (doi:10.1186/s40463-016-0117-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Yong
- University of British Columbia, Division of Otolaryngology - Head and Neck Surgery, 4th Floor, 2775 Laurel Street, Vancouver General Hospital, Vancouver, BC, V5Z 1 M9, Canada.
| | - Tamara Mijovic
- McGill University, Department of Otolaryngology - Head and Neck Surgery, Royal Victoria Hospital - D05.5712, 1001 Décarie Boul, Montreal, H4A 3 J1, Canada.
| | - Jane Lea
- University of British Columbia, Division of Otolaryngology - Head and Neck Surgery, ENT Clinic, 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
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Nassif N. Response to the Letter to the Editor regarding "Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile?" by Nassif et al. [Int. J. Pediatr. Otorhinolaryngol. 2015 (79) (11) 1860-1864]. Int J Pediatr Otorhinolaryngol 2016; 80:110-1. [PMID: 26553401 DOI: 10.1016/j.ijporl.2015.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Nader Nassif
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Piazza Spedali Civili, 1, 25100 Bresica, Italy.
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Sarcu D, Isaacson G. Long-term Results of Endoscopically Assisted Pediatric Cholesteatoma Surgery. Otolaryngol Head Neck Surg 2015; 154:535-9. [DOI: 10.1177/0194599815622441] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022]
Abstract
Objective Routine endoscopic examination during primary surgery decreased the rate of residual cholesteatoma to 18% in our early experience. Based on this, we stopped performing routine second-look surgery in children who were endoscopically free of cholesteatoma at the end of primary surgery. We sought to investigate if second-look procedures after endoscopic-assisted surgery could safely be performed only in children at a high risk of residual disease (extensive inflammation, spontaneously ruptured or fragmented cholesteatoma, residual disease intentionally left). Study Design Case series with chart review. Setting Tertiary pediatric otolaryngology practice. Subjects and Methods Children aged 1 to 16 years who were treated for cholesteatoma over 15-year period by a single surgeon. Extent of disease and endoscopic findings were compared with rates of residual disease. Time to diagnosis of residual disease and prognostic factors were analyzed. Results Forty-two children underwent endoscopically assisted middle ear surgery for cholesteatoma. Of 42 children, 7 (17%) had additional disease found by endoscopy that was missed by microscopy alone. Twelve children at high risk had second looks; 5 (42%) had residual disease. Of 30 children, 2 (7%) presented with macroscopically evident residual cholesteatoma after no planned second look on office follow-up and subsequently underwent reoperation and were cured. Conclusions Selective second-look surgery in high-risk children did not adversely affect outcome as compared with the low-risk group. Cholesteatoma was identified endoscopically in 7 of 42 (17%) children thought to be microscopically free of disease at initial surgery. The endoscope may aid in visualization of difficult middle ear recesses when used to complement microscopy. Further investigation with multicenter data is needed.
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Affiliation(s)
- David Sarcu
- Departments of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Glenn Isaacson
- Departments of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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Ito T, Kubota T, Watanabe T, Futai K, Furukawa T, Kakehata S. Transcanal endoscopic ear surgery for pediatric population with a narrow external auditory canal. Int J Pediatr Otorhinolaryngol 2015; 79:2265-9. [PMID: 26527072 DOI: 10.1016/j.ijporl.2015.10.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/19/2015] [Accepted: 10/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To retrospectively determine the size of the external auditory canal (EAC) in a pediatric population and to describe our experience with transcanal endoscopic ear surgery (TEES) in this pediatric population which had been successfully treated for middle ear disease using TEES. METHODS We analyzed 31 patients ranging in age from 2 to 13 years old (median: 7.6 years) with middle ear disease who underwent TEES between November 2011 and August 2014. Sixteen of these patients had surgery for cholesteatomas; 11 for chronic otitis media; and 4 for malformation of the middle ear. A preoperative CT scan was performed to evaluate the middle ear disease. Transcanal endoscopic tympanoplasty was performed using a rigid endoscope with a 2.7mm outer diameter. Transcanal endoscopic atticoantrotomy was also performed, as necessary, on some patients to access pathologies in the antrum. The values of anterior-posterior diameters and superior-inferior diameters of the bony parts of EAC were measured retrospectively based on the preoperative CT scan data. RESULTS TEES was successfully performed in all 31 pediatric patients without resorting to a retroauricular incision. Twenty-seven patients were evaluated for postoperative hearing levels which were found to fall within an acceptable range and for postoperative air-bone gap (ABG) by pure tone audiometry with a resulting mean of 8.6dB. The smallest anterior-posterior diameters of the external ear canal ranged from 3.2 to 7.1mm (5.0±1.0mm) and the smallest superior-inferior diameters ranged from 3.4 to 10.3mm (5.9±1.3mm). CONCLUSION TEES can be used to safely and effectively treat middle ear disease even in the pediatric population in its narrow EAC.
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Affiliation(s)
- Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan.
| | - Toshinori Kubota
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan
| | - Tomoo Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan
| | - Kazunori Futai
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan
| | - Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata-shi, Yamagata 990-9585, Japan
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Efficacy and Safety of Transcanal Endoscopic Ear Surgery for Congenital Cholesteatomas. Otol Neurotol 2015; 36:1644-50. [DOI: 10.1097/mao.0000000000000857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nassif N, Berlucchi M, Redaelli de Zinis LO. Tympanic membrane perforation in children: Endoscopic type I tympanoplasty, a newly technique, is it worthwhile? Int J Pediatr Otorhinolaryngol 2015; 79:1860-4. [PMID: 26337560 DOI: 10.1016/j.ijporl.2015.08.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/11/2015] [Accepted: 08/14/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the results of a newly introduced technique to our Department of endoscopic assisted transcanal myringoplasty applied in tympanic membrane perforation in children of any age and compare them to that of the previously standard microscopic assisted myringoplasty technique. METHODS A retrospective study of myringoplasties performed between January 2005 and June 2014 in children suffering from chronic otitis media with perforation. In microscope-assisted cases, a transcanal approach was applied when the anterior tympanic annulus was completely visible through the ear speculum, and a postauricular approach was used in all other cases. A transcanal approach was used in all endoscopic-assisted cases. RESULTS Between January 2005 and December 2010 and January 2011 and June 2014, 23 and 22 myringoplasties were performed by means of an operative microscope and an endoscope, respectively. Patient age varied from 5 to 16 years. Median duration of microscopic and endoscopic approaches was 90 min and 80 min (P=0.3), respectively. Hospital stay after surgery was significantly longer in the microscope group than the endoscope group (P<0.001). The intact graft success rate was 82.6% in microscopic and 90.9% in endoscopic approaches. Median postoperative air-bone gap of microscopic and endoscopic approaches was 6.2 dB and 6.6 dB, respectively (P=0.9). Neither intra- nor postoperative complications were observed. CONCLUSION Endoscopic transcanal myringoplasty is an alternative surgical approach to traditional technique. This surgery is more conservative than microscopic approach and can be performed in all pediatric cases independently from age. Moreover, it offers comparable anatomical and functional results to the traditional surgery, and grants better comfort for the child.
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Affiliation(s)
- Nader Nassif
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy.
| | - Marco Berlucchi
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy
| | - Luca Oscar Redaelli de Zinis
- Department of Pediatric Otorhinolaryngology (N.N., M.B.), Spedali Civili, Brescia, Italy; Department of Otorhinolaryngology (L.O.R.Z.), University of Brescia, Brescia, Italy
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45
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46
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Saxby AJ, Fandino M, Kozak FK. Management of traumatic perilymph fistula with endoscopic techniques. ANZ J Surg 2015; 88:E93-E94. [PMID: 26331841 DOI: 10.1111/ans.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alexander J Saxby
- Division of Otolaryngology, Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada.,Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Marcela Fandino
- Division of Otolaryngology, Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Frederick K Kozak
- Division of Otolaryngology, Head and Neck Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
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Cohen MS, Landegger LD, Kozin ED, Lee DJ. Pediatric endoscopic ear surgery in clinical practice: Lessons learned and early outcomes. Laryngoscope 2015; 126:732-8. [DOI: 10.1002/lary.25410] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/06/2015] [Accepted: 05/08/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Michael S. Cohen
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Lukas D. Landegger
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Elliott D. Kozin
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Daniel J. Lee
- Department of Otolaryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
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Marchioni D, Soloperto D, Rubini A, Villari D, Genovese E, Artioli F, Presutti L. Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: our experience. Int J Pediatr Otorhinolaryngol 2015; 79:316-22. [PMID: 25631934 DOI: 10.1016/j.ijporl.2014.12.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach. METHODS A chart review of clinical data and videos from the operations of 54 pediatric patients, undergoing surgery between January 2007 and December 2013, was made. Patients presenting with cholesteatoma involving the tympanic cavity (mesotympanum, epitympanum, protympanum and/or hypotympanum), with no mastoid involvement, were included in the first group and underwent an exclusive transcanalar endoscopic approach (TEA). In case of mastoid extension of the pathology, patients were included in the control group and underwent a canal wall up microscopic technique (CWU). RESULTS In this study, 34 males and 20 females, including 5 bilateral cases, giving a total of 59 ears, were reviewed. Median age was 9.6 years (range 4-16 years). 31 cholesteatomas underwent a TEA approach, while 28 underwent a CWU approach, based on inclusion criteria. No differences from congenital vs acquired form was made, due to the difficult to correctly distinguish always the two forms. The ossicular chain was preserved in 26.6% of patients (16 ears): 42% of patients (13 ears) undergoing a transcanal endoscopic approach and 10% of patients undergoing a canal wall up microscopic approach (3 ears) (P=0.006). Second look surgery was executed in 41.6% of patients (25 ears). In partial ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 29.4dB, while the mean postoperative pure-tone average was 27.1dB, with a mean increase of 2.3dB. In total ossicular prosthesis reconstructions, the mean preoperative pure-tone average was 47.8dB, while the mean postoperative pure-tone average was 26.5dB, with a mean increase of 21.3dB. Recurrence rate was 12.9% (4 ears) for the transcanal endoscopic approach group and 17.2% (5 ears) for the canal wall up microscopic approach. Residual disease was present in 26.6%: 19.3% (6 ears) for the transcanal endoscopic approach group and 34.4% (10 ears) for the canal wall up microscopic approach. The mean follow up was 36 months (range 8-88). Kaplan-Meier analysis at 36 months showed a lower recurrence risk for the transcanal endoscopic approach compared with the canal wall up microscopic approach, but this data was not statistically significant (P=0.58). CONCLUSION The transcanal endoscopic approach represents a feasible, minimally invasive and conservative technique for the management of pediatric middle ear cholesteatoma.
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Affiliation(s)
- Daniele Marchioni
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Davide Soloperto
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy.
| | - Alessia Rubini
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Domenico Villari
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Elisabetta Genovese
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Franca Artioli
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
| | - Livio Presutti
- Otolaryngology Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy
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Migirov L, Yakirevitch A, Wolf M. The utility of minimally invasive transcanal endoscopic approach for removal of residual/recurrent cholesteatoma: preliminary results. Eur Arch Otorhinolaryngol 2014; 272:3241-6. [PMID: 25413019 DOI: 10.1007/s00405-014-3402-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/17/2014] [Indexed: 12/28/2022]
Abstract
To investigate the feasibility of applying the transcanal endoscopic approach (TEA) for surgical treatment of residual/recurrent cholesteatoma and present the preliminary results of 17 revision procedures that were carried out with this minimally invasive approach. The records of 17 patients (aged 5-76 years) who underwent transcanal revision procedure using rigid 3-mm diameter, 0°, 30° and 45° endoscopes between 2009 and 2012 were retrospectively reviewed. A wide posterior tympanomeatal flap was elevated via the external auditory canal and then transposed inferiorly in cases of cholesteatoma situated in the middle ear under a tympanic membrane. In certain cases, cholesteatoma was assessed and removed using the endoscopes directly from the radical cavity or from the mastoid cavity remaining after a canal-wall-down procedure. Six patients had originally undergone the canal-wall-up mastoidectomy, 6 patients had a canal-wall-down mastoidectomy and 5 patients had radical mastoid cavities. The interval between the previous and the index surgery ranged between 1 and 6 years. The attic was the most common site involved with cholesteatoma, followed by the tympanic portion of the facial nerve, sinus tympani, mastoid, supratubal recess, promontory, round and oval windows. The size of residual/recurrent lesion varied between 3 and 15 mm. The patients were followed up 26-67 months (mean 52.1 months). The single recurrence (a 4-mm pearl over the tympanic portion of the facial nerve) was eradicated by a transcanal re-revision 1 year following the index surgery. Minimally invasive TEA can be successfully applied in carefully selected patients with endoscopically accessible cholesteatoma subsequent to various types of mastoidectomy.
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Affiliation(s)
- Lela Migirov
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel.
| | - Arkadi Yakirevitch
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
| | - Michael Wolf
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, 5262l, Tel Aviv, Israel
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Kozin ED, Lehmann A, Carter M, Hight E, Cohen M, Nakajima HH, Lee DJ. Thermal effects of endoscopy in a human temporal bone model: implications for endoscopic ear surgery. Laryngoscope 2014; 124:E332-9. [PMID: 24604692 DOI: 10.1002/lary.24666] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although the theoretical risk of elevated temperatures during endoscopic ear surgery has been reported previously, neither temperature change nor heat distribution associated with the endoscope has been quantified. In this study, we measure temperature changes during rigid middle ear endoscopy in a human temporal bone model and investigate whether suction can act as a significant cooling mechanism. STUDY DESIGN Human temporal bone model of endoscopic middle ear surgery. METHODS Fresh human temporal bones were maintained at body temperature (∼ 36°C). Temperature fluctuations were measured as a function of 1) distance between the tip of a 3-mm 0° Hopkins rod and round window membrane, and 2) intensity of the light source. Infrared imaging determined the thermal gradient. For suction, a 20-Fr suction catheter was utilized. RESULTS We found: 1) an endoscope maximally powered by a xenon or light-emitting diode light source resulted in a rapid temperature elevation up to 46°C within 0.5 to 1 mm from the tip of the endoscope within 30 to 124 seconds, 2) elevated temperatures occurred up to 8 mm from the endoscope tip; and 3) temperature decreased rapidly within 20 to 88 seconds of turning off the light source or applying suction. CONCLUSIONS Our findings have direct implications for avoiding excessive temperature elevation in endoscopic ear surgery. We recommend: 1) using submaximal light intensity, 2) frequent repositioning of the endoscope, and 3) removing the endoscope to allow tissue cooling. Use of suction provides rapid cooling of the middle ear space and may be incorporated in the design of new instrumentation for prolonged dissection.
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Affiliation(s)
- Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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