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Lee YJ, Kang WS, Chung JW. Efficacy and safety of a self-expandable retainer in endoscopic ear surgery. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08838-z. [PMID: 39044062 DOI: 10.1007/s00405-024-08838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE During endoscopic ear surgery (EES), it is important to maintain a clear view of the endoscopic camera to achieve a clean field. In this study, a self-expandable external auditory canal (EAC) retainer was developed to enable a more efficient and safer EES. This study aimed to evaluate the retainer's efficacy and safety in EES. METHODS Among adult patients scheduled for endoscopic tympanoplasty, 50 participants were recruited. They were assigned to either the retainer or control group in a 1:1 ratio. The anatomical characteristics, number of endoscopic cleanings during surgery, surgeon's satisfaction, and other factors were evaluated. RESULTS No differences were observed in the surgical direction, EAC size measured on preoperative temporal bone computed tomography scans, location and size of tympanic membrane perforation, or bleeding degree between the two groups. When comparing the surgical time, including retainer insertion and removal, the time was similar between groups (retainer group, 35 min; control group, 33.2 min). The frequency of endoscopic cleaning per minute was statistically significantly lower in the retainer group than in the control group (0.18 times per minute, p = 0.048). No side effects, including sensory abnormalities or allergic reactions, were reported in any patient who used the retainer. CONCLUSION A reduction in unnecessary endoscopic cleaning during EES was observed while using the self-expandable retainer, leading to increased surgeon satisfaction and efficiency. Furthermore, as a safe method without side effects, the retainer could be widely used to various indications for EES beyond tympanoplasty.
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Affiliation(s)
- Yun Ji Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sacchetto L, Raguso G, Confuorto G, Arietti V, Torroni L, Marchioni D, Nocini R. A comparison between endoscopic and microscopic approaches for stapes surgery: experience of a tertiary referral center. Eur Arch Otorhinolaryngol 2024; 281:2959-2965. [PMID: 38158420 DOI: 10.1007/s00405-023-08411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Otosclerosis is a common ear disease causing ankylosis of the stapedio-vestibular joint and conductive hearing loss. Stapedoplasty is the most advisable surgical solution. The restoration of hearing depends on the condition of the patient and the surgery itself. The aim of our work was to compare the surgical and audiological results of stapedoplasty performed with endoscopic versus microscopic technique. METHODS This is a retrospective study of 254 patients treated with stapedoplasty with a microscopic approach (91/254) or with an endoscopic approach (163/254) between 2014 and 2021 at our tertiary referral center. Statistical significance of differences between the two methods was determined using the Mann-Whitney test for quantitative variables and the Wilcoxon matched-pairs signed-rank test for repeated measures. Categorical variables were assessed with Fisher's exact test. RESULTS Both techniques improved the hearing status of patients, with no statistically significant difference between them. There was also no statistically significant difference in reported complications between the two techniques. There is a statistical difference (p < 0.001) in operating time between the two techniques: the endoscopic technique had a mean operating time of 39 min versus 45 min for the microscopic technique. CONCLUSIONS The two techniques are comparable in terms of results and the choice depends on the surgeon's preferences and experience.
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Affiliation(s)
- L Sacchetto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Raguso
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - G Confuorto
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
| | - V Arietti
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy.
| | - L Torroni
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - D Marchioni
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - R Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, P.Le L.A. Scuro 10, 37134, Verona, Italy
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Wojciechowski T, Bisi N, Szopiński K, Marchioni D. Detailed Radiomorphometric Analysis of the Surgical Corridor for the Suprageniculate Approach. J Pers Med 2024; 14:516. [PMID: 38793098 PMCID: PMC11122192 DOI: 10.3390/jpm14050516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The suprageniculate fossa (SGF) is located between the geniculate ganglion, the middle cranial fossa (MCF) and the anterior semicircular canal (ASCC). An endoscopic transcanal approach has been recently proposed to treat the different lesions in this area. The aim of the study is to describe the anatomical pathway of this approach by measuring the dimensions of its boundaries while checking their correlation with the pneumatization of the SGF area. METHODS This is a retrospective anatomical analysis of Cone Beam CT scans of 80 patients, for a total of 160 temporal bones analyzed. Two checkpoints were measured for the SGF route, as an internal and an external window. These are triangles between the MCF dura, the geniculate ganglion and the ASCC on parasagittal and axial planes. The pneumatization of the SGF was also assessed, classified and correlated with the measured dimensions. RESULTS The depth of the SGF was 7.5 ± 1.8 mm. The width of the external window was 7.5 ± 1.9, 5.6 ± 2.4 and 1.6 ± 1.6 mm for the posterior, middle and anterior points of measurement, respectively. The height of the internal window was 7.6 ± 1.2, 4.5 ± 1.5 and 1.7 ± 1.7 mm for the posterior, middle and anterior points of measurement, respectively. Type A pneumatization was found in 87 cases, type B in 34 and type C in 39. The degree of pneumatization directly correlated to the depth and height of the fossa. CONCLUSIONS The suprageniculate approach route is defined by the internal and external windows which should be evaluated during a pre-surgery imaging assessment. The detailed anatomy of the approach and the novel classification of the pneumatization of the SGF are here described which may be useful to plan a safer procedure with minimal complications.
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Affiliation(s)
- Tomasz Wojciechowski
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St., 02004 Warsaw, Poland;
- Department of Otorhinolaryngology, Head and Neck Surgery, The Medical University of Warsaw, 1a Banacha St., 02097 Warsaw, Poland
| | - Nicola Bisi
- Department of Otorhinolaryngology—Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41125 Modena, Italy;
| | - Kazimierz Szopiński
- Department of Dental and Maxillofacial Radiology, The Medical University of Warsaw, 6 Bienieckiego St., 02097 Warsaw, Poland;
| | - Daniele Marchioni
- Department of Otorhinolaryngology—Head and Neck Surgery, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41125 Modena, Italy;
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Balazova K, Belakova P, Snehota M, Trneckova M, Vachutka J, Salzman R. Comparison of capabilities and limitations of endoscopes in endoscopic ear surgeries using 3D printed models. Am J Otolaryngol 2024; 45:104226. [PMID: 38295450 DOI: 10.1016/j.amjoto.2024.104226] [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: 12/04/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE Endoscopic ear surgery has become a popular operative approach to treat middle ear diseases. Surgeons use either 0° or 30° endoscopes worldwide. The main aim of the work was to compare the properties of these two types of endoscopes. MATERIAL AND METHODS Since this type of evaluation is hard to perform in vivo during the actual surgery, we designed 3D printed temporal bone models with different levels of complexity. The evaluation of endoscopes was based on image analysis or visibility of anatomical structures. RESULTS The results show that a 30° endoscope offers a view of lateral walls from 4 mm distance, contrary to a 0° endoscope which cannot see lateral walls from this distance at all. On the other hand, visible area of the anterior wall is up to 40 % larger using 0° endoscope, compared to 30° endoscope. Angled endoscope distorts the picture and leads to the deterioration of the image. At commonly used distances above 5 mm from middle ear structures, resolution and image distortion is comparable between both endoscopes. CONCLUSIONS Our results do not offer a definitive opinion on which endoscope is better for ear surgery. Both types of endoscopes have advantages and disadvantages, and the choice depends on the surgeon's personal preference and on the type of planned procedure.
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Affiliation(s)
- Klara Balazova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, Olomouc 775 15, Czech Republic.
| | - Petra Belakova
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 7, Olomouc 779 00, Czech Republic.
| | - Martin Snehota
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, Olomouc 775 15, Czech Republic.
| | - Marketa Trneckova
- Department of Computer Science, Faculty of Science, Palacky University Olomouc, 17. listopadu 12, Olomouc 779 00, Czech Republic.
| | - Jaromir Vachutka
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, Olomouc 775 15, Czech Republic.
| | - Richard Salzman
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 7, Olomouc 779 00, Czech Republic.
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Fu X, Wu J, Lyu J, Chen B, Wang W, Chi F, Yuan Y, Ren D. Microscopic Versus Endoscopic Ear Surgery for Early-Stage Glomus Tympanicum Tumors. EAR, NOSE & THROAT JOURNAL 2024:1455613231222384. [PMID: 38217439 DOI: 10.1177/01455613231222384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
Purpose: Glomus tympanicum tumors are benign primary tumors of the middle ear that can be completely removed using modern surgery. We compared endoscopic ear surgery (EES) to traditional microscopic ear surgery (MES) in terms of the removal of early-stage glomus tympanicum tumors. Methods: We retrospectively reviewed 25 cases treated from 2003 to 2021 that were of Grade I or II based on the Glasscock-Jackson classification system. Overall, 18 cases underwent MES: 8 via trans-tympanic bone and 10 via canal-wall-down or canal-wall-up tympanomastoidectomy (CWDT or CWUT) and 7 underwent EES. We compared surgery durations, the lengths and costs of hospitalization, postoperative complications, and relapse rates between the two groups and among the three specific operation ways. Results: The postoperative follow-up period ranged from 1 to 19 years. There was no between-group difference in operative time or the length or cost of hospitalization. Operative time and cost of hospitalization did not show a statistically significant correlation to the three surgical procedures, whereas it was found that the group of MES via the trans-tympanic bone had shorter length of hospitalization when compared with CWUT or CWDT group. All tumors were completely resected; pulsatile tinnitus improved in all patients, and there was no major complication. Two patients who underwent CWUT or CWDT (one each) relapsed; no patient relapsed in the EES group. Conclusion: MES via the trans-tympanic bone and EES via the ear canal safely and reliably remove early-stage tumors without excessive patient discomfort.
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Affiliation(s)
- Xiao Fu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jingfang Wu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Jihan Lyu
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Binjun Chen
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Fanglu Chi
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Yasheng Yuan
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
| | - Dongdong Ren
- Department of Otology and Skull Base Surgery, Eye & ENT Hospital of Fudan University, Shanghai, China
- Shanghai clinical medical center of hearing medicine, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Shanghai, China
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Chorda tympani injury during endoscopic versus microscopic stapes surgery: a randomized controlled clinical trial. Eur Arch Otorhinolaryngol 2023; 280:689-693. [PMID: 35871441 PMCID: PMC9849188 DOI: 10.1007/s00405-022-07550-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of this study was to compare the incidence of chorda tympani nerve (CTN) injury between endoscopic and microscopic stapes surgery. METHODS This randomized controlled clinical trial included 88 patients who were randomly divided into two groups: endoscopic stapedotomy group (n = 44) and microscopic stapedotomy group (n = 44). The incidence of chorda tympani nerve (CTN) injury after surgery was determined by both subjective taste testing and chemical taste tests, before and after surgery. The results were compared between the two groups. RESULTS The total number of patients who were identified as having CTN affection (based on the chemical testing) was 16 out of 88 (18.2%). The incidence was significantly lower in the endoscopic group (n = 2) than the microscopic group (n = 14) (p = 0.019). CONCLUSION Altered taste as a result of iatrogenic CTN injury can affect the patients' quality of life. Endoscopic ear surgery offers better visualization, less need for extensive manipulation of the chorda tympani, and consequently decreased incidence of CTN injury.
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Tu LJ, Fina M, Golub JS, Kazahaya K, Quesnel AM, Tawfik KO, Cohen MS. Current Trends in Endoscopic Ear Surgery. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e023. [PMID: 38516579 PMCID: PMC10950159 DOI: 10.1097/ono.0000000000000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 03/23/2024]
Affiliation(s)
- Leona J. Tu
- Drexel University College of Medicine, Philadelphia, PA
| | - Manuela Fina
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Justin S. Golub
- Department of Otolaryngology—Head and Neck Surgery, Valegos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kareem O. Tawfik
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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8
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Endoscopic Ear Surgery: Past and Future. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang D, Hugo W, Bergsneider M, Wang MB, Kim W, Vinters HV, Heaney AP. Single-cell RNA sequencing in silent corticotroph tumors confirms impaired POMC processing and provides new insights into their invasive behavior. Eur J Endocrinol 2022; 187:49-64. [PMID: 35521707 PMCID: PMC9248914 DOI: 10.1530/eje-21-1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/21/2022] [Indexed: 11/08/2022]
Abstract
Objective Provide insights into the defective POMC processing and invasive behavior in silent pituitary corticotroph tumors. Design and methods Single-cell RNAseq was used to compare the cellular makeup and transcriptome of silent and active corticotroph tumors. Results A series of transcripts related to hormone processing peptidases and genes involved in the structural organization of secretory vesicles were reduced in silent compared to active corticotroph tumors. Most relevant to their invasive behavior, silent corticotroph tumors exhibited several features of epithelial-to-mesenchymal transition, with increased expression of mesenchymal genes along with the loss of transcripts that regulate hormonal biogenesis and secretion. Silent corticotroph tumor vascular smooth muscle cell and pericyte stromal cell populations also exhibited plasticity in their mesenchymal features. Conclusions Our findings provide novel insights into the mechanisms of impaired POMC processing and invasion in silent corticotroph tumors and suggest that a common transcriptional reprogramming mechanism simultaneously impairs POMC processing and activates tumor invasion.
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Affiliation(s)
- Dongyun Zhang
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Willy Hugo
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Marilene B. Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Won Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Harry V. Vinters
- Department of Pathology and Lab Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Anthony P. Heaney
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles
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Zhou Q, Jin L, Song X, Zheng H, Huang Y. Endoscopic type 1 tympanoplasty: comparison of the effects of three different thicknesses grafts. Acta Otolaryngol 2022; 142:375-380. [PMID: 35549633 DOI: 10.1080/00016489.2022.2071987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The effects of graft thickness on tympanoplasty is uncertain. OBJECTIVE To compare the results of endoscopic tympanoplasty using different thicknesses of autologous tissues. METHODS This retrospective analysis included 186 patients who received type I tympanoplasty, divided into three main groups based of grafting material: perichondrium (A), cartilage-perichondrium (B), or cartilage-perichondrium plus additional perichondrium (C). Group A was subdivided based on whether the placement was inside (A1) or outside (A2) of the malleus. The hearing improvement, graft success rate, and surgery duration were analysed. RESULTS Statistical analysis showed significant hearing improvement in the three main groups (p < .001); recovery in group A occurred the earliest. Six months postoperatively, group A1 showed significantly greater hearing recovery compared with groups B and C (p < .05). There were no statistical differences the other groups (p > .05) or in the graft success rate among the three main groups (p = .235). The surgery duration of group A was significantly longer than that of groups B and C (p < .001). CONCLUSION AND SIGNIFICANCE Our results suggest that graft thickness affects hearing recovery; however, graft thickness does not affect the rate of grafting success. Endoscopic transplantation of the perichondrium is more difficult and requires more time.
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Affiliation(s)
- Qinshuang Zhou
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Lanlan Jin
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Xiaoxiao Song
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Haifeng Zheng
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
| | - Yideng Huang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China
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Li J, Jufas N, Forer M, Patel N. Incidence and trends of middle ear cholesteatoma surgery and mastoidectomy in Australia-A national hospital morbidity database analysis. Laryngoscope Investig Otolaryngol 2022; 7:210-218. [PMID: 35155800 PMCID: PMC8823164 DOI: 10.1002/lio2.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia. STUDY DESIGN Cross-sectional population-based study using data from the National Hospital Morbidity Database. METHODS Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods. RESULTS Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2-9.0) and 8.1 per 100,000 (95% CI: 7.7-8.5) for 2017-2018 and 2007-2008, respectively. Population aged 10-19 years had the highest age-specific incidence rate at 12.5 per 100,000 (95% CI: 11.3-13.9) for 2017-2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41-1.86], P <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61-0.78], P <.001]). CONCLUSIONS The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. Level of evidence: 4.
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Affiliation(s)
- Jonathan Li
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nicholas Jufas
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
| | - Martin Forer
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nirmal Patel
- Division of Otolaryngology Head & Neck SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Department of Otolaryngology – Head & Neck Surgery, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Kolling Deafness Research Centre, Royal North Shore HospitalMacquarie University and University of SydneySydneyNew South WalesAustralia
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Efficacy of Otomicroscopy Combined with Otoendoscopy Double-Lens Technology-Assisted Tympanic Membrane Repair on Elderly Patients with Chronic Suppurative Otitis Media. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5164907. [PMID: 34603469 PMCID: PMC8483917 DOI: 10.1155/2021/5164907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/04/2022]
Abstract
Objective To investigate the effect of otomicroscopy combined with otoendoscopy double-lens technology-assisted tympanic membrane repair on elderly patients chronic suppurative otitis media (CSOM). Methods 120 elderly CSOM patients from January 2017 to July 2019 were selected and divided into the otomicroscopy group (n = 40), the otoendoscopy group (n = 40), and the double-lens group (n = 40) by the random number method. All patients were treated with tympanic membrane repair. The otomicroscopy group was assisted by otomicroscopy, the otoendoscopy group was assisted by otoendoscopy. and the double-lens group was assisted by otomicroscopy combined with otoendoscopy. The three groups of operations status, clinical efficacy, the incidence of adverse reactions, hearing improvement rate, and satisfaction rate with incision after 6 months were compared. Results The operation time, intraoperative blood loss, hospitalization time, and VAS score of the otoendoscopy group and the double-lens group were all lower than those of the otoendoscopy group, and the operation time of the double-lens group was lower than that of the otoendoscopy group (P < 0.05). The clinical efficacy of the double-lens group was better than that of the otomicroscopy group and otoendoscopy group (P < 0.05). The adverse reaction rate of the otoendoscopy group and the double-lens group was lower than that of the otomicroscopy group, and the average postoperative air-bone conductance of the double-lens group was lower than that of the otomicroscopy group and the otoendoscopy group, and the hearing improvement rate was higher than that of the otomicroscopy and otoendoscopy groups (P < 0.05). The satisfaction rate with postoperative incision in the otoendoscopy group and double-lens group was higher than that in the otomicroscopy group (P < 0.05). Conclusion The double-lens technology-assisted tympanic membrane repair has an obvious effect on elderly patients with CSOM. Compared with the single-use otomicroscopy, the operation time, intraoperative blood loss, hospitalization time, patient's dry ear condition, degree of surgical pain, clinical efficacy, adverse reaction rate, hearing improvement rate, and patient's incision satisfaction of the double-lens technology are better. Compared with the single-use otoendoscopy, the operation time, clinical efficacy, and hearing improvement rate of the double-lens technology are better.
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[Endoscopic ear surgery in Germany : Survey on the current situation and an international comparison]. HNO 2021; 69:779-790. [PMID: 34417641 PMCID: PMC8378297 DOI: 10.1007/s00106-021-01094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Endoscopic ear surgery (EES) has become firmly established internationally. In Germany this technology is controversially discussed and used very differently. Therefore, a survey was carried out on the availability, indications, contraindications, and future significance of EES. METHODS A questionnaire with 20 questions was sent to 141 German university and central departments of otorhinolaryngology, head and neck surgery. The results are discussed on the basis of current literature retrieved in a search of PubMed and Google Scholar. RESULTS The response rate was 32% (45 clinics). Of these respondents, 27 clinics (60%) stated that EES was usually carried out as an accompanying measure. Only one clinic performed ear surgery endoscopically alone. In cases of intraoperative bleeding, mastoid drilling, or if bimanual work was required, the surgeons switched to microscopic ear surgery (MES). The most common indications for EES were tympanoscopy, cholesteatoma, retraction pockets, and interventions on the tympanic membrane and external auditory canal. The necessary resources for EES were estimated to be higher than for MES in 49-50% of the responding clinics. Tragus cartilage dominated as the graft material for reconstruction in EES clinics, at 78%. Only 4 of 45 responding clinics rated the future significance of ESS in Germany as high. CONCLUSION Although EES is used in Germany, only few ENT clinics use it extensively. Reservations relate to one-handed working, drilling, management of bleeding, and the expected high resource demand. Thus, EES in Germany is often performed as an accompanying procedure, with switching between EES and MES.
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