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Takata Y, Anzai T, Sonoda K, Okada H, Ishimizu E, Nakamura M, Hara S, Nakayama T, Matsumoto F. Combined underwater endoscopic and microscopic surgery for tympanic paraganglioma: A case report. Sci Prog 2024; 107:368504241263524. [PMID: 39043202 PMCID: PMC11271120 DOI: 10.1177/00368504241263524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The resection of middle ear paragangliomas can be challenging given their vascular nature and the small volume of the tympanic cavity, particularly when the tumor in the hypotympanum is close or attached to the internal carotid artery (ICA). We performed combined underwater endoscopic and microscopic surgery for a Class B1 middle ear paraganglioma according to the modified Fisch classification. The suspicious bone in the hypotympanum and around the petrous ICA was drilled with underwater endoscopy. The feeding arteries, the caroticotympanic and inferior tympanic arteries, were suctioned and cauterized under microscopy. To the best of our knowledge, no case of middle ear paraganglioma treated with underwater endoscopy has been reported. Underwater endoscopy, providing a clear operative field with blood and bone dust irrigation, is a good indication for middle ear paragangliomas. In contrast, microscopic preparation for unexpected bleeding is important, particularly when the tumor closely extends to vital structures, such as the ICA or the jugular bulb.
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Affiliation(s)
- Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenji Sonoda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Erina Ishimizu
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takumi Nakayama
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Anzai T, Takata Y, Hara S, Sonoda K, Ikeda K, Okada H, Matusmoto F. Combined underwater endoscopic and microscopic surgery for external auditory canal cholesteatoma: A case report. EAR, NOSE & THROAT JOURNAL 2024; 103:413-415. [PMID: 34875889 DOI: 10.1177/01455613211064011] [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: 11/17/2022] Open
Abstract
Transcanal endoscopic ear surgery is a minimally invasive procedure that allows a clear visualization of the middle ear. Recently, indications for endoscopic surgery have been expanding. We performed combined underwater endoscopic and microscopic surgery for external auditory canal cholesteatoma, the computer tomography of which indicates the possibility of cholesteatoma not only in the canal wall but also in the mastoid. The 30° endoscope and underwater technique makes the surgical view clear, and we could remove the cholesteatoma without canalplasty. To the best of our knowledge, no case of external auditory canal cholesteatoma treated with underwater endoscopic and microscopic surgery has been previously reported. This case indicates that the procedure could be a good indication for external auditory canal cholesteatoma.
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Affiliation(s)
- Takashi Anzai
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Kenji Sonoda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
| | - Fumihiko Matusmoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine Tokyo, Tokyo, Japan
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Suzuki M, Ota Y, Takanami T, Yoshino R, Masuda H. Superior canal dehiscence syndrome: A review. Auris Nasus Larynx 2024; 51:113-119. [PMID: 37640595 DOI: 10.1016/j.anl.2023.08.004] [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: 01/06/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Superior canal dehiscence syndrome (SCDS) is a vestibular disorder in which the presence of a pathological third window in the labyrinth causes several vestibular and cochlear symptoms. Herein, we review the diagnostic criteria and treatment of SCDS. The cause of SCDS is considered to be congenital or acquired; however, its etiology is not well known. Symptoms: Vertigo and/or oscillopsia induced by loud sounds (Tullio phenomenon) or stimuli that change the middle ear or intracranial pressure (fistula symptoms) with vestibular symptoms and hyperacusis and aural fullness with cochlear symptoms are characteristic clinical complaints of this syndrome. Neurological tests: Vertical-torsional eye movements can be observed when the Tullio phenomenon or fistula symptoms are induced. Conductive hearing loss with both a decrease in the bone conduction threshold at lower frequencies and an increase in the air conduction threshold at lower frequencies may be present on audiometry. Cervical and/or ocular vestibular evoked myogenic potentials are effective in strongly suspecting the presence of a pathologic third window in the labyrinth. Computed tomography (CT) imaging: High-resolution CT findings with multiplanar reconstruction in the plane of the superior semicircular canal consistent with dehiscence indicate SCDS. The Pöschl view along the plane of the superior semicircular canal and the Stenvers view perpendicular to it are recommended as CT imaging conditions. Findings from all three major diagnostic categories (symptoms, neurological tests, and/or CT imaging) are needed to diagnose SCDS. The surgical approaches for SCDS are as follows: the 1) middle cranial fossa approach, 2) transmastoid approach, and 3) round window and oval window reinforcement. Each technique has advantages and disadvantages.
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Affiliation(s)
- Mitsuya Suzuki
- Department of Otolaryngology, Toho University Sakura Medical Center, 564-1 Shimo-shizu, Sakura City, Chiba 285-0841, Japan.
| | - Yasushi Ota
- Department of Otolaryngology, Toho University Sakura Medical Center, 564-1 Shimo-shizu, Sakura City, Chiba 285-0841, Japan
| | - Taro Takanami
- Department of Otolaryngology, Toho University Sakura Medical Center, 564-1 Shimo-shizu, Sakura City, Chiba 285-0841, Japan
| | - Ryosuke Yoshino
- Department of Otolaryngology, Toho University Sakura Medical Center, 564-1 Shimo-shizu, Sakura City, Chiba 285-0841, Japan
| | - Hiroaki Masuda
- Department of Otolaryngology, Toho University Sakura Medical Center, 564-1 Shimo-shizu, Sakura City, Chiba 285-0841, Japan
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Yang HH, Lum M, Kaur T, Yang I, Gopen QS. Postoperative Pneumolabyrinth Following the Middle Cranial Fossa Approach for Superior Semicircular Canal Dehiscence Repair, 2014-2020. Otolaryngol Head Neck Surg 2023; 168:453-461. [PMID: 35727631 DOI: 10.1177/01945998221106688] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The present study investigates risk factors and clinical outcomes of postoperative pneumolabyrinth following the middle cranial fossa approach for superior semicircular canal dehiscence repair, a complication that has not been documented previously. STUDY DESIGN Retrospective cohort study. SETTING Tertiary/quaternary care referral center. METHODS We conducted a retrospective review of 332 middle cranial fossa procedures from 2014 to 2020 at a tertiary/quaternary care institution. Upon identifying pneumolabyrinth cases from postoperative computed tomography temporal bone scans, we conducted multivariable logistic regression analysis to explore demographic and clinical factors that were independently linked to this complication. We also compared the rates of postoperative symptoms among patients with different grades of pneumolabyrinth. RESULTS We identified 41 (12.3%) pneumolabyrinth cases. Patients with older age, higher preoperative pure tone average, and frank dehiscence were at higher risk for pneumolabyrinth. Furthermore, patients with pneumolabyrinth reported significantly higher rates of postoperative dizziness and exhibited significantly greater pure tone average and air-bone gap postoperatively as compared with patients without pneumolabyrinth. Finally, higher-grade pneumolabyrinth was associated with increased rates of postoperative hearing loss, and grade III pneumolabyrinth was associated with higher rates of postoperative tinnitus vs grade I and II cases. CONCLUSION Pneumolabyrinth following the middle cranial fossa approach was associated with poor clinical outcomes, including dizziness and auditory impairment. Old age, high preoperative pure tone average, and frank dehiscence were risk factors for this complication. The highlighted parameters may be important to note when considering this approach as a treatment option and while monitoring postoperative recovery.
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Affiliation(s)
- Hong-Ho Yang
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Meachelle Lum
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Taranjit Kaur
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Quinton S Gopen
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Zhang Q, Zhang L, Zeng N, Hu J, Li S, Gao C, Yang Q. Canalplasty using underwater bone drilling in transcanal endoscopic myringoplasty for patients with a narrow external auditory canal. Acta Otolaryngol 2022; 142:543-548. [PMID: 35895385 DOI: 10.1080/00016489.2022.2099014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Canalplasty is important in microscopic ear surgery, but it has rarely been studied in otoendoscopic surgery. OBJECTIVES The aim of this study was to investigate the application of canalplasty due to external auditory canal stenosis caused by bony bulges in endoscopic myringoplasty. MATERIALS AND METHODS The procedures and effects of canalplasties and myringoplasties were analysed. During the canalplasties, depending on the location of the bulges, the meatal skin flaps were elevated in different manners, and the underwater bone drilling technique was adopted to remove the bulges to enlarge the osseous canals. RESULTS Canalplasties were performed in 18.5% (33/178) of myringoplasties. All surgeries were completed exclusively via the transcanal endoscopic approach. No iatrogenic injuries were found. Most of the canalplasties required drilling off bulges on multiple walls. The mean total duration of the canalplasties and myringoplasties was 76.6 ± 4.5 min, and the proportion of time required for the canalplasties was 47.3 ± 2.4%. CONCLUSION Only approximately one in five endoscopic myringoplasties require antecedent canalplasties due to concurrent canal stenosis. With the underwater bone drilling technique, transcanal endoscopic canalplasty can be safely and efficiently conducted.
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Affiliation(s)
- Quanming Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Lue Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Nan Zeng
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Jing Hu
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Shuo Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Chunsheng Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
| | - Qiong Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, P. R. China
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Kawamura Y, Yamauchi D, Kobayashi T, Ikeda R, Kawase T, Katori Y. Hearing Outcomes of Transmastoid Plugging for Superior Canal Dehiscence Syndrome by Underwater Endoscopic Surgery: With Special Reference to Transient Bone Conduction Increase in Early Postoperative Period. Otol Neurotol 2022; 43:368-375. [PMID: 34999616 DOI: 10.1097/mao.0000000000003461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the influence on hearing of transmastoid plugging of the superior semicircular canal accompanied with membranous superior canal transection by underwater endoscopic ear surgery (UWEES) for the superior semicircular canal dehiscence syndrome. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Seven patients underwent plugging with membranous superior canal transection with UWEES from 2017 to 2019. INTERVENTION Bone conduction (BC) thresholds (250, 500, 1000, 2000, 4000 Hz) were repetitively examined in early postoperative period. MAIN OUTCOME MEASURES Subjective symptoms and pure-tone audiometry. RESULTS Transient BC threshold increase was detected in all cases in early postoperative period and hearing levels were ameliorated in 1 to 2 months. The mean maximum BC threshold elevations (dB) during the early postoperative period (within 1 mo) and the postoperative stable hearing period (after 2 mo) were 18.6 and 2.9 at 250 Hz, 24.3 and 8.6 at 500 Hz, 26.4 and 8.6 at 1000 Hz, 28.6 and 7.1 at 2000 Hz, and 30.0 and 0.8 (except for scale-out cases) at 4000 Hz. respectively. The mean maximum BC thresholds in the early period were significantly elevated compared with those in the stable period at each frequency (p < 0.01). CONCLUSIONS Hearing outcomes of transmastoid plugging with transection of the membranous superior canal by using UWEES were found favorable in a long-term follow-up. However, it caused transient reversible hearing loss in all cases. The BC increase in early postoperative period may not cause permanent hearing loss but improvement for the surgical technique may still be necessary.
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Affiliation(s)
- Yoshinobu Kawamura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Daisuke Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Toshimitsu Kobayashi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
- Sen-En Rifu Otologic Surgery Center, Miyagi, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai
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Transcanal Endoscopic Ear Surgery for Advanced External Auditory Canal Cholesteatoma in Naim Stage III and IV. Otol Neurotol 2021; 42:e1698-e1705. [PMID: 34766954 DOI: 10.1097/mao.0000000000003378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the clinical characteristics and treatment outcomes, as well as endoscopic-assisted ear surgery techniques used in patients with advanced external auditory canal cholesteatoma (EACC). STUDY DESIGN Retrospective case series. SETTING University hospital. METHODS From October 2014 to September 2017, adult patients (age > 18) with advanced EACC (Naim's classification: stage III or IV) who underwent transcanal endoscopic ear surgery (TEES) were enrolled. The presenting features, extent of the lesion, and reconstruction techniques used were assessed. The healing time which was defined as the time required to develop a dry, re-epithelialized, and self-cleaning external auditory canal, was compared between stage III and IV. RESULTS Twenty-three patients were included. EACC was categorized as stage III in 11 ears and stage IV in 12 ears. Cholesteatoma involved the mastoid (30%), middle ear (26%), chorda tympani (22%), temporomandibular joint, antrum, and facial nerve (17% for each). In 96% of patients, a dry and self-cleaning external auditory canal (EAC) was maintained after a mean follow-up of 15 months. The median healing time was 8 weeks in stage III, which was significantly shorter than the 12 weeks required for stage IV (p < 0.05). There was no significant difference in the median healing time between TEES and the canal wall up mastoidectomy for stage IV EACC (14 weeks) performed by the same surgeon over the same period (p > 0.05). CONCLUSIONS TEES is a feasible and safe technique for the exposure and eradication of advanced EACC. Some critical endoscopic techniques for resecting disease and reconstructing the defect in the EAC and middle ear should be mastered before performing this operation.
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Makihara S, Okano M, Miyamoto S, Uraguchi K, Tsumura M, Kariya S, Ando M. Underwater posterior nasal neurectomy compared to resection of peripheral branches of posterior nerve in severe allergic rhinitis. Acta Otolaryngol 2021; 141:780-785. [PMID: 34380375 DOI: 10.1080/00016489.2021.1925151] [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: 10/20/2022]
Abstract
BACKGROUND Several surgical procedures for posterior nasal neurectomy have been reported, but no conclusion has been reached about which procedure is best. OBJECTIVES The aim is to evaluate the improvement in symptom medication scores for resection of the posterior nasal nerve trunk in an underwater environment, with submucous inferior turbinectomy, without injuring the sphenopalatine artery (SPA) in severe allergic rhinitis. MATERIAL AND METHODS Improvements in symptom medication scores were retrospectively compared between 27 consecutive cases who underwent resection of the posterior nasal nerve trunk with turbinoplasty in an underwater environment without injuring the SPA (Underwater group) and, as a historical control, 16 consecutive cases who underwent resection of peripheral branches of the posterior nasal nerve with turbinoplasty (Control group). RESULTS The improvements in symptom medication scores in the Underwater group were significantly better than in the Control group (3.07 vs. 1.96, p = 0.02). CONCLUSIONS AND SIGNIFICANCE By using underwater posterior nasal neurectomy, we can easily and safely resect the posterior nasal nerve trunk under a clear surgical view without injuring the SPA. This technique with submucous inferior turbinectomy may, more than resection of peripheral branches of the posterior nasal nerve, be able to reduce the medication score and symptom medication score.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Mitsuhiro Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Syotaro Miyamoto
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Kensuke Uraguchi
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Munechika Tsumura
- Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Mizuo Ando
- Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Underwater Endoscopic Ear Surgery for Closure of Cholesteatomatous Labyrinthine Fistula With Preservation of Auditory Function. Otol Neurotol 2021; 42:e1669-e1676. [PMID: 34172658 DOI: 10.1097/mao.0000000000003241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the outcomes of the underwater endoscopic ear surgery (UWEES) technique for closure of cholesteatomatous labyrinthine fistula (LF) with preservation of auditory function. STUDY DESIGN Retrospective case review study. SETTING Tertiary referral center. PATIENTS A total of 12 patients with cholesteatomatous LF. INTERVENTION Surgical method of closure using UWEES for cholesteatomatous LF to minimize inner ear damage. Artificial cerebrospinal fluid (CSF) was used as the perfusate, except for earlier cases when saline was employed. MAIN OUTCOME MEASURES Comparison of bone conductance hearing level (BCHL) before and after surgery. A change of BCHL less than 10 dB was defined as successful preservation of bone conductance hearing. RESULTS All cases of LF were treated successfully by closure using the UWEES technique. Seven cases were type I, one was type IIa, and four were type III according to the Milewski and Dornhoffer classification of LF. The average LF size was 3.1 mm (1-7 mm). Eleven patients were evaluated and their bone conductance hearing was well preserved in all of them (11/11). One patient was too young for preoperative evaluation of BCHL, but hearing preservation was verified 2 years later at the age of 6 years. Remarkably, none of the patients complained of vertigo, except for only a slight manifestation on postoperative day 1. CONCLUSION The UWEES technique was effective for closure of cholesteatomatous LF with preservation of auditory function.
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Takata Y, Anzai T, Hara S, Okada H, Matsumoto F, Ikeda K. Cholesteatoma Surgery With a Dehiscent High Jugular Bulb Treated With Surgery Assisted With Underwater Endoscopy: A Case Report. EAR, NOSE & THROAT JOURNAL 2021:1455613211009135. [PMID: 33915058 DOI: 10.1177/01455613211009135] [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] [Indexed: 11/16/2022] Open
Abstract
A dehiscent high jugular bulb would be a pitfall in middle ear surgery especially for cholesteatoma. We report a case of cholesteatoma attached to a dehiscent high jugular bulb successfully treated with surgery assisted with underwater endoscopy. To the best of our knowledge, no previous study has reported a case of cholesteatoma with dehiscent high jugular bulb treated with surgery assisted with underwater endoscopy. Owing to the risk of jugular bulb injury, underwater endoscopy is a good indication for middle ear cases with a dehiscent high jugular bulb to obtain a clear operative field and avoid an unexpected air embolism.
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Affiliation(s)
- Yusuke Takata
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Anzai
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Hara
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroko Okada
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otorhinolaryngology, 12847Juntendo University Faculty of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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Abstract
: Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal (SCC). Patients with SCD Syndrome (SCDS) may experience symptoms such as aural fullness, pulsatile tinnitus, hyperacusis, autophony, or pressure or noise-induced vertigo . The defect can be repaired in various ways, but there is potential for loss of perilymphatic fluid during transmastoid approaches that could result in postoperative sensorineural hearing loss . We hypothesize that if the procedure were performed "underwater" in balanced salt solution (BSS), loss of perilymphatic fluid would be minimized. CASE REPORT:: A 55-year-old male presented with right-sided autophony, pulsatile tinnitus, and hyperacusis. Audiometric testing demonstrated a low-frequency airbone gap and a supranormal bone-conduction threshold at 4 kHz. Ocular VEMP responses were increased amplitude. Temporal bone imaging revealed a SCC dehiscence.The patient was taken to the operating room for an underwater, endoscopic repair of the SCC using a transmastoid approach. A cortical mastoidectomy was performed using Landmarx image navigation. BSS filled the mastoid and a 0-degree endoscope with endoscrub was used to see the SCC underwater. The SCC was entered near the ampullated end with a bur. A stepwise plugging process included applying strips of wet and dried fascia and bone dust. The non-ampullated end was similarly plugged. BSS was suctioned, and under microscopic visualization, labyrinthotomies were capped with bone chips. The patient tolerated the procedure well and was discharged the next day. There was no sensorineural hearing loss postoperatively. CONCLUSION:: SCDS may be addressed surgically using multiple approaches. An underwater endoscopic repair of the SCC may be safe and effective surgical treatment.SDC video link: http://links.lww.com/MAO/A808.
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The outcomes of endoscopic approach for attic cholesteatoma: underwater continuous drilling versus traditional intermittent drilling. The Journal of Laryngology & Otology 2021; 135:310-314. [PMID: 33726879 DOI: 10.1017/s0022215121000633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to analyse the differences between underwater continuous drilling and traditional intermittent drilling for attic cholesteatoma. METHODS The clinical data of 61 patients with attic cholesteatoma who underwent an endoscopic approach procedure were analysed. Forty patients underwent underwater continuous drilling (group A), and 21 patients underwent traditional intermittent drilling (group B). RESULTS The operation time was 64.61 ± 12.90 minutes in group A and 79.60 ± 16.81 minutes in group B (p < 0.05). The anaesthesia time was 102.69 ± 17.93 minutes in group A and 119.82 ± 19.28 minutes in group B (p < 0.05). The dry ear time, the hearing improvement rate and the post-operative complications were no different in the two groups. CONCLUSION Group A and group B had no differences in surgical outcome or hearing recovery. However, treatment in the former group resulted in a significantly shortened operation and anaesthesia time.
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Ridge SE, Shetty KR, Lee DJ. Current trends and applications in endoscopy for otology and neurotology. World J Otorhinolaryngol Head Neck Surg 2021; 7:101-108. [PMID: 33997719 PMCID: PMC8103526 DOI: 10.1016/j.wjorl.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/28/2020] [Indexed: 01/03/2023] Open
Abstract
There has been a rapid increase in endoscopic ear surgery for the management of middle ear and lateral skull base disease in children and adults over the last decade. In this review paper, we discuss the current trends and applications of the endoscope in the field of otology and neurotology. Advantages of the endoscope include excellent ergonomics, compatibility with pediatric anatomy, and improved access to the middle ear through the external auditory canal. Transcanal endoscopic ear surgery has demonstrated comparable outcomes in the management of cholesteatoma, tympanic membrane perforations, and otosclerosis as compared to microscopic approaches, while utilizing less invasive surgical corridors and reducing the need for postauricular incisions. When a postauricular approach is required, the endoscopic-assisted transmastoid approach can avoid a canal wall down mastoidectomy in cases of cholesteatoma. The endoscope also has utility in treatment of superior canal dehiscence and various skull base lesions including glomus tumors, meningiomas, and vestibular schwannomas. Outside of the operating room, the endoscope can be used during examination of the outer and middle ear and for debridement of complex mastoid cavities. For these reasons, the endoscope is currently poised to transform the field of otology and neurotology.
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Affiliation(s)
- Sarah E Ridge
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Kunal R Shetty
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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The Treatment of Cholesteatomas Involving the Antrum and Mastoid Using Transcanal Underwater Endoscopic Ear Surgery. Otol Neurotol 2020; 41:1379-1386. [PMID: 32947491 DOI: 10.1097/mao.0000000000002813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and safety of transcanal underwater endoscopic bone resection (TUEBR) of the external auditory canal (EAC) for the management of cholesteatoma involving the antrum and mastoid. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Pediatric and adult patients with primary cholesteatoma extending to the antrum and mastoid who underwent transcanal endoscopic ear surgery (TEES) with TUEBR between March 2016 and June 2017. INTERVENTION A rigid 2.7 mm diameter, 18 cm length Hopkins-rod telescope with an endoscopic sheath was inserted in the EAC and continuously perfused with saline during the dissection. TUEBR was performed to expose extensive cholesteatoma by using a high speed drill with curved burrs and a protected shaft. Next, removal of visible disease, reconstruction of the resected EAC, ossiculoplasty, and tympanoplasty were accomplished with TEES. RESULTS There were no intra- or postoperative severe complications such as facial palsy and inner ear injury except one patient suffering from secondary labyrinthitis. There was a negative linear relationship (r = -0.909) between the procedure time and procedure number of TUEBR. There was a weak relationship (r = 0.224) between the procedure time of TUEBR and the degree of the extension of cholesteatoma into the antrum and mastoid. There were two cases with residual cholesteatoma at 12 and 22 months follow-up postoperatively. CONCLUSION TUEBR is a safe and efficient technique for the resection of EAC bone and transcanal exposure of extensive cholesteatoma that would otherwise require mastoid dissection.
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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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