The flexible endaural tympanoplasty: pathology-guided, pathogenesis-oriented surgery for the middle ear

Comprehensive management of chronic ear disease: Consecutive patient analysis at a tertiary children's hospital

OBJECTIVE

To characterize medical complexity and advanced interventions necessary to treat pediatric patients with chronic ear disease.

METHODS

A retrospective case review of children who received surgery for chronic otitis media, cholesteatoma, or tympanic membrane perforation at a tertiary children's hospital from 2020 to 2024 was performed. The frequency and type of medical complexities as well as distribution and success of advanced otologic interventions were recorded.

RESULTS

Operations were performed on 80 ears. Forty-five percent were in medically complex patients. Twenty-five percent had a syndrome, 13 % had American Society for Anesthesiologists Severity Class 3 or more, and 38 % attended multi-disciplinary programs. Advanced audiology testing protocols were utilized in 53 % of patients, and multiple children received complex sleep and airway operations. Advanced surgical techniques were required in 58 %. Post-operatively, an intact tympanic membrane was achieved in 95 % of operated ears (p < 0.01). Residual and recurrent cholesteatoma were each present in 5 % of cases, with mean follow-up of 11.6 months. Otorrhea reduced from 64 % of patients pre-operatively to 2 % post-operatively (p < 0.01), including cessation in all individuals who reported social/bullying issues related to ear drainage/odor. Unrestricted water exposure was achieved in 99 % of individuals (p < 0.01). Patients showed a mean improvement after surgery of 7.6 dB, as measured by the change in air-bone gap (p < 0.05).

CONCLUSIONS

Comprehensive treatment of otologic conditions included care that was holistic of all medical needs, integrated with other services, developmentally appropriate, encompassing of non-otologic procedures, technically advanced, effective, and functionally-focused. Surgical teams should endeavor together to provide this combination of services.

Central versus marginal tympanic membrane perforations: does it matter? An analysis of 792 patients

BACKGROUND

There is a lack of studies concerning chronic otitis media without cholesteatoma.

OBJECTIVES

To perform an analysis of tympanic membrane perforations (TMP), compare the parameters of central and marginal TMP, combining both the traditional and more recent technologies available.

MATERIAL AND METHODS

792 consecutive patients. The TMP subgroups were divided by central and marginal locations and compared based on signs suggestive of previous tympanic retraction, namely, medialized malleus, tympanic remnants over the promontory, tympanic remnants over the ossicular chain, and incus/stapes erosion. Analysis of the status of the contralateral ear (CLE).

RESULTS

Central TMP was diagnosed in 79.8%. Compared with the central group, the marginal group had more reported hearing loss (95.6%), greater conductive hearing loss (pure tone average for air-conduction 43.3 dB and average air-bone gap of 28.7 dB), a larger perforated area (46.45%), more posteroinferior quadrant involvement, a greater number retraction signs prior to the TMP, and more changes in the CLE (71%).

CONCLUSION

The differences between TMP subgroups are highlighted when we use all technologies available to compare them. Marginal TMPs have more altered parameters than central TMPs.

SIGNIFICANCE

There is a great possibility to enhance the knowledge of TMPs and to improve the pathogenesis-based treatment.

Classifications of Mastoid and Middle Ear Surgery: A Scoping Review

OBJECTIVES

The aim of this scoping review was to evaluate existing classifications of surgical procedures of the middle ear and mastoid and find a suitable classification that could serve as an international standard.

MATERIALS AND METHODS

Scoping review with a systematic literature search using reference tracking and a syntax including all surgical procedures in mastoid and middle ear surgery and their synonyms. Studies were selected based on inclusion and exclusion criteria.

RESULTS

Eleven reported classifications were included; six of which focused on middle ear surgery, two on mastoid surgery, and three on both. However, none of the classifications included all current surgical procedures of mastoid and middle ear surgery.

CONCLUSION

Many classifications have been proposed for innumerable surgical techniques in middle ear and mastoid surgery. Some are outdated, some are incomplete, most are not widely accepted, and only few correspond with all current surgical techniques.

Comparison of Conventional Versus Spiral Computed Tomography with Three Dimensional Reconstruction in Chronic Otitis Media with Ossicular Chain Destruction

Background:

Chronic otitis media (COM) can be treated with tympanoplasty with or without mastoidectomy. In patients who have undergone middle ear surgery, three-dimensional spiral computed tomography (CT) scan plays an important role in optimizing surgical planning.

Objectives:

This study was performed to compare the findings of three-dimensional reconstructed spiral and conventional CT scan of ossicular chain study in patients with COM.

Patients and Methods:

Fifty patients enrolled in the study underwent plane and three dimensional CT scan (PHILIPS-MX 8000). Ossicles changes, mastoid cavity, tympanic cavity, and presence of cholesteatoma were evaluated. Results of the two methods were then compared and interpreted by a radiologist, recorded in questionnaires, and analyzed. Logistic regression test and Kappa coefficient of agreement were used for statistical analyses.

Results:

Sixty two ears with COM were found in physical examination. A significant difference was observed between the findings of the two methods in ossicle erosion (11.3% in conventional CT vs. 37.1% in spiral CT, P = 0.0001), decrease of mastoid air cells (82.3% in conventional CT vs. 93.5% in spiral CT, P = 0.001), and tympanic cavity opacity (12.9% in conventional CT vs. 40.3% in spiral CT, P=0.0001). No significant difference was observed between the findings of the two methods in ossicle destruction (6.5% conventional CT vs. 56.4% in spiral CT, P = 0.125), and presence of cholesteatoma (3.2% in conventional CT vs. 42% in spiral CT, P = 0.172). In this study, spiral CT scan demonstrated ossicle dislocation in 9.6%, decrease of mastoid air cells in 4.8%, and decrease of volume in the tympanic cavity in 1.6%; whereas, none of these findings were reported in the patients' conventional CT scans.

Conclusion:

Spiral-CT scan is superior to conventional CT in the diagnosis of lesions in COM before operation. It can be used for detailed evaluation of ossicular chain in such patients.

Contralateral ear in chronic otitis media: a histologic study

OBJECTIVE

The objective of this study is to determine the prevalence of the contralateral ear changes in human temporal bones of donors with chronic otitis media.

STUDY DESIGN

Transversal.

MATERIAL AND METHODS

The temporal bones were examined under light microscopy and then described. Chronic otitis media was defined by the presence of irreversible inflammatory alterations in the middle ear cleft. The contralateral ear was defined as the normal or the less affected ear. To compare the qualitative variables, the chi test was used. Spearman's nonparametric test was used for correlations. P values less than or equal to .05 were considered significant.

RESULTS

We studied 85 pairs of temporal bones. Cholesteatoma was observed in 22.4% of the more damaged ears. The prevalence of contralateral ears with alterations was 91.8%. The main alterations were granulation tissue (81%), effusion (58%), and tympanic membrane retractions (35%). There was a direct and moderately strong correlation between the extent of granulation tissue in the more damaged ear and the contralateral ear (r(s) = 0.345, P = .004). A strong correlation was observed between the extent of cholesteatoma in the more damaged ear and in the contralateral ear (rs = 0.617, P < .001).

CONCLUSION

We observed a high prevalence of changes in the contralateral ear. There was a direct correlation between the extent of both granulation tissue and cholesteatoma between the two ears, demonstrating that the more extensive the manifestation of these pathologies in the more damaged ear, the greater they will be in the contralateral ear.