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Erfurt C, Westerhout SF, Straatman LV, Smit AL, Stokroos RJ, Thomeer HGXM. Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes. Front Surg 2024; 11:1381481. [PMID: 38650663 PMCID: PMC11033303 DOI: 10.3389/fsurg.2024.1381481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques. Methods A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) (p = 0.013). Interventions All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma. Main outcome measures The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing. Results In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903). Conclusions Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.
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Affiliation(s)
- Chiara Erfurt
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne F. Westerhout
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Louise V. Straatman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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Zeng L, Xie L, Hu J, He C, Liu A, Lu X, Zhou W. Osteopontin-driven partial epithelial-mesenchymal transition governs the development of middle ear cholesteatoma. Cell Cycle 2024; 23:537-554. [PMID: 38662954 PMCID: PMC11135870 DOI: 10.1080/15384101.2024.2345481] [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: 09/10/2023] [Accepted: 04/17/2024] [Indexed: 05/28/2024] Open
Abstract
Cholesteatoma is a common disease of the middle ear. Currently, surgical removal is the only treatment option and patients face a high risk of relapse. The molecular basis of cholesteatoma remains largely unknown. Here, we show that Osteopontin (OPN), a predominantly secreted protein, plays a crucial role in the development of middle ear cholesteatoma. Global transcriptome analysis revealed the loss of epithelial features and an enhanced immune response in human cholesteatoma tissues. Quantitative RT-PCR and immunohistochemical staining of middle ear cholesteatoma validated the reduced expression of epithelial markers, as well as the elevated expression of mesenchymal markers including Vimentin and Fibronectin, but not N-Cadherin, α-smooth muscle actin (α-SMA) or ferroptosis suppressor protein 1 (FSP1), indicating a partial epithelial-mesenchymal transition (EMT) state. Besides, the expression of OPN was significantly elevated in human cholesteatoma tissues. Treatment with OPN promoted cell proliferation, survival and migration and led to a partial EMT in immortalized human keratinocyte cells. Importantly, blockade of OPN signaling could remarkably improve the cholesteatoma-like symptoms in SD rats. Our mechanistic study demonstrated that the AKT-zinc finger E-box binding homeobox 2 (ZEB2) axis mediated the effects of OPN. Overall, these findings suggest that targeting the OPN signaling represents a promising strategy for the treatment of middle ear cholesteatoma.
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Affiliation(s)
- Lingling Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Xie
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jin Hu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao He
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aiguo Liu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Lu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Zhou
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Kopczyk R, Jurkiewicz D, Rogowski M, Szydłowski M, Wierzbicka M. Off-label drugs in otolaryngological practice against the background of legal conditions of Polish legislation. OTOLARYNGOLOGIA POLSKA 2024; 78:36-43. [PMID: 38332710 DOI: 10.5604/01.3001.0054.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
<b><br>Introduction:</b> 'Off-label drug use' refers to the administration of drugs for unapproved indications or age groups, a different dosage or other form of administration. Considering the legal issues, there clearly exists a need to implement rules that would regulate the use of pharmaceuticals outside the scope of a marketing authorisation. The brevity and diversity of Polish laws in the field of health care leads to many interpretative doubts associated with particular legal acts.</br> <b><br>Aim:</b> We aimed to present clinical examples from everyday practice of off-label drug use from the medical and legal perspectives, and to support it with relevant legal acts.</br> <b><br>Material and method:</b> Off-label drug use in various otolaryngology subspecialties - otology (mesna), laryngology (bevacizumab, cidofovir and botulinum toxin) and head and neck surgery (botulinum toxin) - are presented and discussed in detail.</br> <b><br>Results:</b> Fourteen Polish legal acts regarding off-label drug use and 4 from EU legislation are commented on. The algorithm of cascade of decision-making processes in off-label drug use is shown.</br> <b><br>Conclusions:</b> Off-label use of medicinal products is not prohibited in Poland or the EU; nevertheless, it is undeniable that the unclear legal situation regarding the use of medicinal products for nonregistered indications creates difficulties. To minimise a doctor's liability risk, obtaining the informed consent from the patient for such treatment is advisable.</br>.
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Affiliation(s)
- Renata Kopczyk
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Dariusz Jurkiewicz
- Clinic of Otolaryngology and Oncological Otolaryngology with the Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Poland
| | - Maciej Szydłowski
- Wroclaw Regional Specialist Hospital, Research & Development Centre, Wrocław, Poland
| | - Małgorzata Wierzbicka
- Wroclaw University of Science and Technology, Wroclaw, Poland, Wroclaw Regional Specialist Hospital, Research & Development Centre, Wrocław, Poland
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Daoudi H, Levy R, Baudouin R, Couloigner V, Leboulanger N, Garabédian EN, Belhous K, Boddaert N, Denoyelle F, Simon F. Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up. Otolaryngol Head Neck Surg 2024; 170:221-229. [PMID: 37313857 DOI: 10.1002/ohn.398] [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: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.
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Affiliation(s)
- Hannah Daoudi
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Raphaël Levy
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Robin Baudouin
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Leboulanger
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eréa-Noel Garabédian
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kahina Belhous
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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Solis-Pazmino P, Siepmann T, Scheffler P, Ali NES, Lincango-Naranjo E, Valdez TA, Prokop LJ, Min-Woo Illigens B, Ponce OJ, Ahmad IN. Canal wall up versus canal wall down mastoidectomy techniques in the pediatric population with cholesteatoma: A systematic review and meta-analysis of comparative studies. Int J Pediatr Otorhinolaryngol 2023; 173:111658. [PMID: 37666040 DOI: 10.1016/j.ijporl.2023.111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 09/06/2023]
Abstract
IMPORTANCE The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of canal wall-up (CWU) versus canal wall-down (CWD) procedures. Pediatric cholesteatoma has high rates of recurrence (16%-54%). In adults, there is evidence that the selection of surgical techniques affects recurrence rates. This has not been shown in children. OBJECTIVES 1. To systematically review the literature on recurrent and residual cholesteatoma after CWU and CWD in children and perform a meta-analysis of the data. 2. To assess the rates of recurrent and residual cholesteatoma between CWU and CWD techniques in pediatric patients. 3. To assess hearing outcomes by evaluating postoperative differences in the air-bone gap (ABG) between CWU and CWD techniques. DATA SOURCES A systematic search of PubMed, Embase, Scopus, and Cochrane Collaboration was performed from inception to May 1st, 2020, to identify studies that compared CWU and CWD procedures for acquired cholesteatoma in children. STUDY SELECTION Search records were screened in duplicate by four reviewers. Inclusion criteria consisted of comparative randomized clinical trials and observational studies assessing outcomes of CWU and CWD techniques in the pediatric population. Studies involving patients with congenital cholesteatoma were excluded. DATA EXTRACTION AND SYNTHESIS Four reviewers working independently and in duplicate systematically reviewed and extracted study data. Dichotomous variables were analyzed as risk ratios (RR), while continuous variables were compared using weighted mean differences (MD). The risk of bias was assessed using the CLARITY Scale. PRIMARY OUTCOMES AND MEASURES The outcomes were recurrence, residual disease, air-bone gap (ABG), and air conductive (AC) thresholds. RESULTS After screening 1036 publications, 17 retrospective cohort studies were selected. 1333 children were included; the overall mean age was ten years (SD 7.9), and the overall mean follow-up time was 5.9 years (SD 6.6). CWU and CWD techniques were performed in 60% (796) and 40% (537) cases. We did not find differences in cholesteatoma recurrence (RR: 1.50, 95% CI 0.94; 2.40; n = 544; I2 0%; Tau [2]: 0.00), or rates of residual cholesteatoma (RR 1.51, 95% CI 0.96; 2.38, n = 506; I2: 0%; Tau [2]: 0.00) in patients who underwent CWU and CWD mastoidectomy. The mean air-bone gap was lower with CWU than CWD (mean difference: 7.60, 95% CI -10.65; -4.54; n = 242; I2: 71%; Tau [2]: 5.98). CONCLUSION and relevance: We show similar rates of recurrence and residual disease after either CWU or CWD tympanoplasty. Our results challenge the fundamental principle of CWD surgery as a standard technique, as there is no difference in rates of recurrence and residual disease in CWU and CWD. Moreover, audiometric results support CWU with improved hearing outcomes. TRIAL REGISTRATION PROSPERO identifier: CRD42020184029.
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Affiliation(s)
- Paola Solis-Pazmino
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care, Dresden International University, Dresden, Germany; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Patrick Scheffler
- Department of Otolaryngology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Noor-E-Seher Ali
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Larry J Prokop
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Iram N Ahmad
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA.
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Pietraszek M, Bartochowska A, Wierzbicka M, Gawęcki W. The assesment of intraoperative use of mesna in canal wall-up cholesteatoma surgery - preliminary report. OTOLARYNGOLOGIA POLSKA 2023; 77:1-6. [PMID: 37772375 DOI: 10.5604/01.3001.0016.3415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> Surgery is still the method of choice in chronic otitis media with cholesteatoma. Except for some specific clinical situations, classic canal wall up technique (CWU), remains a gold standard as a primary treatment in most departments. Unfortunately, the risk of recurrence in such an approach is estimated at 9 to even 70%. This fact prompts researchers to look for ways to reduce those unfavourable statistics. One of the recognized methods supporting the removal of cholesteatoma is the intraoperative use of mesna (sodium 2-mercaptoethanesulfonate). This synthetic sulphur compound disrupts disulfide bridges in polypeptide chains, thanks to which it facilitates matrix preparation.</br></br> <b>Aim:</b> To evaluate the effect of intraoperative use of mesna on the treatment outcomes in patients with chronic otitis media with cholesteatoma operated on by means of the canal wall up technique (CWU).</br></br> <b>Material and methods:</b> 459 surgical reports of patients with middle ear cholesteatoma were analyzed. In total, 52 adult patients with no history of previous ear surgery operated on by means of the CWU technique by the same experienced otosurgeon with all follow-up data available were included in the study. Twenty-six were operated on with the use of mesna (mesna group) and 26 by means of the classic CWU technique (control / no-mesna group). There were 28 women and 24 men with a mean age of 41 years.</br></br> <b>Main Outcome Measure(s):</b> Postoperative hearing results and cholesteatoma recidivism rate.</br></br> <b>Results:</b> Overall recidivism rate was 21.15 %. It was higher in the no-mesna (26.9%) than in the mesna group (15.4%) - although the outcomes were better in the mesna group, the difference was not statistically significant (P = 0.49715). Hearing gain was better in the mesna than in the no-mesna group (10 dB vs 7 dB), but the difference was not statistically significant (P = 0.20089).</br></br> <b>Conclusions:</b> Our preliminary results show that mesna reduces recidivism rates in patients with cholesteatoma. Further study with the analysis of a larger group of patients is needed to prove it statistically.
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Affiliation(s)
- Marta Pietraszek
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Nakazawa T, Yamamoto Y, Kanno K, Kurihara S, Takahashi M, Morino T, Motegi M, Yamamoto K, Sakurai Y, Kojima H. Time Analysis of Recidivism in Acquired Cholesteatoma Using the Kaplan-Meier Method. Otol Neurotol 2023; 44:e393-e397. [PMID: 37254255 DOI: 10.1097/mao.0000000000003908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To analyze the time trends of recidivism of acquired cholesteatoma using the Kaplan-Meier method. STUDY DESIGN We conducted a retrospective, observational study of 256 patients having their first cholesteatoma surgery. The cumulative recidivism-free rate was calculated using Kaplan-Meier survival analysis related to the follow-up period, pathophysiology, the extent of the disease, and recidivism pathologies. RESULTS Pars flacida cholesteatoma with tympanic cavity progression had a high likelihood of recurrence disease. Pars tensa cholesteatoma led to more recurrence of the disease than the residual disease. In both pars flacida and pars tensa cholesteatoma, the incidence of disease recurrence increased even 3 years after surgery. On the contrary, the incidence of residual disease peaked within 3 years after surgery, and thereafter, the incidence of residual disease tended to be small. In particular, pars flacida cholesteatoma extending into the mastoid cavity or tympanic cavity tended to recur up to 5 years postoperatively. CONCLUSIONS We calculated the cumulative recidivism-free rates of 256 patients with cholesteatoma using Kaplan-Meier survival analysis. These results can lead to better estimates of the length of the follow-up period. LEVEL OF EVIDENCE Level IV evidence from case-control studies.
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Affiliation(s)
- Takara Nakazawa
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
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Kroon VJ, Mes SW, Borggreven PA, van de Langenberg R, Colnot DR, Quak JJ. Cholesteatoma surgery in the pediatric population: remaining challenges in the era of mastoid obliteration. Eur Arch Otorhinolaryngol 2023; 280:1713-1722. [PMID: 36208330 PMCID: PMC9988747 DOI: 10.1007/s00405-022-07669-0] [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: 05/09/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. METHODS A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. RESULTS A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan-Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0-1) was achieved in 98% of the cases. Closure of the air-bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. CONCLUSION In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.
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Affiliation(s)
- Victor J Kroon
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
- Faculty of Medicine, University Utrecht, Utrecht, The Netherlands.
| | - Steven W Mes
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
- Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Pepijn A Borggreven
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Rick van de Langenberg
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - David R Colnot
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Jasper J Quak
- Department of Otolaryngology and Head and Neck Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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Ruffin WC, Crouch JB, Burruss CP, Bush ML. Sociodemographic Factors and Health Care Utilization in Pediatric Chronic Suppurative Otitis Media. Laryngoscope 2023; 133:700-705. [PMID: 35567375 DOI: 10.1002/lary.30213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Access to and utilization of perioperative healthcare may influence outcomes in patients with chronic suppurative otitis media (CSOM); however, the influencing factors are poorly understood. The objective of this study was to assess the association of sociodemographic factors with perioperative health care utilization for pediatric CSOM patients. METHODS We conducted a review on pediatric CSOM patients (≤18 years old) who underwent tympanoplasty with/without mastoidectomy between 2010 and 2020. Sociodemographic data and clinical were collected on all participants. Univariate and multivariate logistic regression analysis was conducted to assess the association between these factors and perioperative care utilization. RESULTS 427 patients were included in the study. The primary factor associated with health care utilization was insurance status. Rural children were more likely to have Medicaid insurance (p = 0.048). For tympanoplasty patients, Medicaid patients have 1.66 higher odds of pre-operative no-shows (p = 0.01), 1.31 higher odds of post-operative no-shows (p = 0.02), and 59% lower odds of having a postoperative audiogram (p = 0.01), and 2.64 higher odds of being from a rural community (p = 0.02). For patients undergoing mastoidectomy, Medicaid patients have 1.25 higher odds of postoperative no-shows (p = 0.01), 39% lower odds of having a revision procedure for ossicular reconstruction (p = 0.045). Appalachian rural mastoidectomy patients had 3.62 higher odds of having cholesteatoma (p = 0.05). CONCLUSION Pediatric patients with CSOM who have Medicaid insurance, especially those who reside in rural regions, are at risk for lower perioperative hearing health care utilization. As these findings may impact care delivery and clinical outcomes, efforts should be focused on promoting utilization among these populations. LEVEL OF EVIDENCE 4 Laryngoscope, 133:700-705, 2023.
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Affiliation(s)
- William C Ruffin
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
| | - Jacob B Crouch
- College of Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Clayton P Burruss
- College of Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky, U.S.A
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10
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Diffusion-weighted magnetic resonance imaging for diagnosis of post-operative paediatric cholesteatoma. J Laryngol Otol 2022; 137:484-489. [PMID: 36184898 DOI: 10.1017/s0022215122002055] [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: 03/21/2023]
Abstract
OBJECTIVES High rates of recidivism are reported after paediatric cholesteatoma surgery. Our practice has adapted to include non-echoplanar diffusion-weighted magnetic resonance imaging for the diagnosis of residual or recurrent cholesteatoma. This audit aimed to evaluate the performance of non-echoplanar diffusion-weighted magnetic resonance imaging in our paediatric population. METHODS A retrospective review was conducted of non-echoplanar diffusion-weighted magnetic resonance imaging scans performed to detect residual disease or recurrence after surgery for cholesteatoma in children from 1 January 2012 to 30 November 2017 in our centre. Follow-up diffusion-weighted magnetic resonance imaging scans were reviewed to 16 August 2019. RESULTS Thirty-four diffusion-weighted magnetic resonance imaging scans were included. The sensitivity and specificity values of diffusion-weighted magnetic resonance imaging for detecting post-operative cholesteatoma were 81 per cent and 72 per cent, respectively. Positive predictive and negative predictive values were 72 per cent and 81 per cent, respectively. CONCLUSION Use of diffusion-weighted magnetic resonance imaging is recommended as a replacement for routine second-look surgical procedures in the paediatric population. However, we would caution that patients require close follow up after negative diffusion-weighted magnetic resonance imaging findings.
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11
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Illés K, Meznerics FA, Dembrovszky F, Fehérvári P, Bánvölgyi A, Csupor D, Hegyi P, Horváth T. Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis. Laryngoscope 2022; 133:1297-1305. [PMID: 36169349 DOI: 10.1002/lary.30413] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/18/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data. METHODS The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified. RESULTS A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time. CONCLUSION Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data. LEVEL OF EVIDENCE NA Laryngoscope, 2022.
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Affiliation(s)
- Kata Illés
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | - Fanni Adél Meznerics
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Biomathematics and Informatics, University of Veterinary Medicine, Budapest, Hungary
| | - András Bánvölgyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.,Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
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12
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Schürmann M, Goon P, Sudhoff H. Review of potential medical treatments for middle ear cholesteatoma. Cell Commun Signal 2022; 20:148. [PMID: 36123729 PMCID: PMC9487140 DOI: 10.1186/s12964-022-00953-w] [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: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Middle ear cholesteatoma (MEC), is a destructive, and locally invasive lesion in the middle ear driven by inflammation with an annual incidence of 10 per 100,000. Surgical extraction/excision remains the only treatment strategy available and recurrence is high (up to 40%), therefore developing the first pharmaceutical treatments for MEC is desperately required. This review was targeted at connecting the dysregulated inflammatory network of MEC to pathogenesis and identification of pharmaceutical targets. We summarized the numerous basic research endeavors undertaken over the last 30+ years to identify the key targets in the dysregulated inflammatory pathways and judged the level of evidence for a given target if it was generated by in vitro, in vivo or clinical experiments. MEC pathogenesis was found to be connected to cytokines characteristic for Th1, Th17 and M1 cells. In addition, we found that the inflammation created damage associated molecular patterns (DAMPs), which further promoted inflammation. Similar positive feedback loops have already been described for other Th1/Th17 driven inflammatory diseases (arthritis, Crohn’s disease or multiple sclerosis). A wide-ranging search for molecular targeted therapies (MTT) led to the discovery of over a hundred clinically approved drugs already applied in precision medicine. Based on exclusion criteria designed to enable fast translation as well as efficacy, we condensed the numerous MTTs down to 13 top drugs. The review should serve as groundwork for the primary goal, which is to provide potential pharmaceutical therapies to MEC patients for the first time in history. Video Abstract
Middle ear cholesteatoma (MEC) is a destructive and locally invasive ulcerated lesion in the middle ear driven by inflammation which occurs in 10 out of 100,000 people annually. Surgical extraction/excision is the only treatment strategy available and recurrence is high (up to 40% after ten years), therefore developing the first pharmaceutical treatments for MEC is desperately required. This review is focused on the connections between inflammation and MEC pathogenesis. These connections can be used as attack points for pharmaceuticals. For this we summarized the results of research undertaken over the last 30 + years. MEC pathogenesis can be described by specific inflammatory dysregulation already known from arthritis, Crohn’s disease or multiple sclerosis. A hallmark of this dysregulation are positive feedback loops of the inflammation further amplifying itself in a vicious circle-like manner. We have identified over one hundred drugs which are already used in clinic to treat other inflammatory diseases, and could potentially be repurposed to treat MEC. To improve and expedite clinical success rates, we applied certain criteria based on our literature searches and condensed these drugs down to the 13 top drugs. We hope the review will serve as groundwork for the primary goal, which is to provide potential pharmaceutical therapies to MEC patients for the first time in history.
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Affiliation(s)
- Matthias Schürmann
- Department of Otolaryngology, Head and Neck Surgery, Universität Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Peter Goon
- Department of Otolaryngology, Head and Neck Surgery, Universität Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.,Department of Medicine, National University of Singapore, and National University Health System, Singapore, Singapore
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Universität Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
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13
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The Relationship between the M1/M2 Macrophage Polarization and the Degree of Ossicular Erosion in Human Acquired Cholesteatoma: An Immunohistochemical Study. J Clin Med 2022; 11:jcm11164826. [PMID: 36013064 PMCID: PMC9410162 DOI: 10.3390/jcm11164826] [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: 06/19/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
The differential involvement of the macrophage activation phenotypes (M1 vs. M2) has been linked to disease severity in various chronic inflammatory disorders. Pharmacologic manipulation of the M1/M2 macrophage polarization has shown therapeutic potential. Cholesteatoma is a destructive chronic middle ear disease with potentially life-threatening complications. The distribution of macrophage polarization phenotypes in middle ear cholesteatoma has not been described. In the present study, human cholesteatoma specimens acquired during tympanomastoidectomy were retrospectively retrieved and immunohistochemically characterized using a combination of antibodies labeling M1 macrophages (CD80), M2 macrophages (CD163), and total macrophages (CD68). The correlations between the immunohistochemical findings and clinical presentation were assessed. The findings revealed that cholesteatomas with more extensive ossicular erosion demonstrated a significantly higher number of M1 (CD80+) cells and a higher M1/M2 ratio than less invasive cholesteatomas (Wilcoxon test, p < 0.05). The extent of ossicular erosion correlated significantly with the M1/M2 ratio (Spearman correlation coefficient ρ = 0.4, p < 0.05). Thus, the degree of ossicular erosion in human acquired cholesteatoma appears to be related to the M1/M2 macrophage polarization. The investigation of macrophage polarization and functions in various clinical presentations of middle ear cholesteatoma is of great interest since it may contribute to the development of pharmaceutical treatment approaches.
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14
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So JH, Sobucki S, Szewczyk J, Marturi N, Tamadazte B. Shared Control Schemes for Middle Ear Surgery. Front Robot AI 2022; 9:824716. [PMID: 35391943 PMCID: PMC8980232 DOI: 10.3389/frobt.2022.824716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 11/21/2022] Open
Abstract
This paper deals with the control of a redundant cobot arm to accomplish peg-in-hole insertion tasks in the context of middle ear surgery. It mainly focuses on the development of two shared control laws that combine local measurements provided by position or force sensors with the globally observed visual information. We first investigate the two classical and well-established control modes, i.e., a position-based end-frame tele-operation controller and a comanipulation controller. Based on these two control architectures, we then propose a combination of visual feedback and position/force-based inputs in the same control scheme. In contrast to the conventional control designs where all degrees of freedom (DoF) are equally controlled, the proposed shared controllers allow teleoperation of linear/translational DoFs while the rotational ones are simultaneously handled by a vision-based controller. Such controllers reduce the task complexity, e.g., a complex peg-in-hole task is simplified for the operator to basic translations in the space where tool orientations are automatically controlled. Various experiments are conducted, using a 7-DoF robot arm equipped with a force/torque sensor and a camera, validating the proposed controllers in the context of simulating a minimally invasive surgical procedure. The obtained results in terms of accuracy, ergonomics and rapidity are discussed in this paper.
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Affiliation(s)
- Jae-Hun So
- CNRS UMR 7222, INSERM U1150, ISIR, F-75005, Sorbonne Université, Paris, France
- *Correspondence: Jae-Hun So,
| | - Stéphane Sobucki
- CNRS UMR 7222, INSERM U1150, ISIR, F-75005, Sorbonne Université, Paris, France
| | - Jérôme Szewczyk
- CNRS UMR 7222, INSERM U1150, ISIR, F-75005, Sorbonne Université, Paris, France
| | - Naresh Marturi
- Extreme Robotics Lab, University of Birmingham, Birmingham, United Kingdom
| | - Brahim Tamadazte
- CNRS UMR 7222, INSERM U1150, ISIR, F-75005, Sorbonne Université, Paris, France
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15
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Baba A, Matsushima S, Fukuda T, Yamauchi H, Fujioka H, Hasumi J, Yoshimoto S, Shoji T, Kurihara S, Yamamoto Y, Kojima H, Kurokawa R, Kurokawa M, Ota Y, Ojiri H. Improved assessment of middle ear recurrent/residual cholesteatomas using temporal subtraction CT. Jpn J Radiol 2022; 40:271-278. [PMID: 34689305 PMCID: PMC8891190 DOI: 10.1007/s11604-021-01209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/10/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate the usefulness of temporal subtraction CT (TSCT) of temporal bone CT for the detection of postoperative recurrent/residual cholesteatoma of the middle ear. METHODS Thirty-two consecutive patients with surgically proven postoperative recurrent/residual cholesteatoma and 14 consecutive patients without recurrent/residual lesion matched the selection criteria and were retrospectively evaluated. TSCT imaging was generated with the use of serial postoperative CT. Two experienced radiologists and two residents evaluated the presence of bone erosive change by comparison serial CT studies, and CT and TSCT. The detection rate of bone erosive change, sensitivity and specificity of the recurrence/residual lesions, and reading time for each reader were evaluated. RESULTS TSCT + CT significantly improved the detection of bone erosive changes compared to CT-only evaluation (17.4-41.3% vs. 37.0-58.7%, p = 0.008-0.046). The mean sensitivity and specificity of TSCT + CT for experienced radiologists were 0.77 and 1.00, and 0.52 and 0.97 without TSCT. The mean sensitivity and specificity of TSCT + CT for residents were 0.64 and 1.00, and 0.41 and 1.00 without TSCT. Sensitivity showed an increase in all readers. The use of TSCT significantly reduced the reading time per case in all readers (p < 0.001). CONCLUSION TSCT improves the depiction of newly occurring progressive bone erosive changes, and detection sensitivity and reading time in postoperative recurrence/residual cholesteatoma of middle ear.
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Affiliation(s)
- Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroaki Fujioka
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Jun Hasumi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shohei Yoshimoto
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomokazu Shoji
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Sho Kurihara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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16
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Anikin IA, Bokuchava TA. [Functional results of surgical treatment of patients with various types of acquired cholesteatoma]. Vestn Otorinolaringol 2021; 86:35-41. [PMID: 34783471 DOI: 10.17116/otorino20218605135] [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: 11/17/2022]
Abstract
OBJECTIVE To study the long-term functional results of surgical treatment of patients with acquired cholesteatoma, their dependence on the age of patients, the type of cholesteatoma and the type of surgery. MATERIAL AND METHODS The article presents the results of a dynamic comparison of the functional results of surgical treatment of 332 adults and 104 children with various forms of acquired middle ear cholesteatoma who underwent both closed and open surgical procedures. RESULTS There were no statistically significant differences in hearing function into two age's groups depending on the type of cholesteatoma acquired. Average air conduction in adult patients for all types of cholesteatoma were ranked within 34.55-44.19 dB, air-bone gaps - 24.14-31.12 dB; in children - 33.72-39.16 dB and 27.33-34.95 dB, respectively. The exception was a group of adult patients with secondary cholesteatoma of the pars tensa. In the postoperative period, in patients of both age groups with all types of cholesteatoma, an improvement in the average values of air conduction by 18-20 dB and a decrease in the average values of the air-bone thresholds by 17-21 dB were noted. Analysis of the results of open surgical interventions showed a somewhat worse functional efficiency on 5-9 dB for air conduction average and 18-20 dB for air-bone gaps, both for adults and children. The stability of the achieved level of auditory function at all stages of postoperative observation was also noted. CONCLUSION Surgical treatment of children and adult with all types of acquired cholesteatoma can improve hearing function and achieve stable results when using closed or open types of operations.
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Affiliation(s)
- I A Anikin
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - T A Bokuchava
- Bayandin Murmansk Regional Clinical Hospital, Murmansk, Russia
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Fontes Lima A, Carvalho Moreira F, Sousa Menezes A, Esteves Costa I, Azevedo C, Sá Breda M, Dias L. Is pediatric cholesteatoma more aggressive in children than in adults? A comparative study using the EAONO/JOS classification. Int J Pediatr Otorhinolaryngol 2020; 138:110170. [PMID: 32705986 DOI: 10.1016/j.ijporl.2020.110170] [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: 03/10/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION chronic otitis media with cholesteatoma (COMC) is a serious condition that may cause severe complications. According to the literature, in pediatric patients this entity can have a more aggressive behavior, leading to higher rates of morbidity. Consensus regarding the definition of aggressive and extensive cholesteatoma was lacking until recently. European Academy of Otology and Neurotology/Japan Otologic Society (EAONO/JOS) proposed a classification and staging system which was highly accepted by a group of otology experts. OBJECTIVE to compare cholesteatoma characteristics between pediatric and adult patients using the EAONO/JOS stating system. MATERIAL AND METHODS a retrospective analysis of the patients who underwent surgery for cholesteatoma treatment in a tertiary hospital was performed using EAONO/JOS classification. Congenital cholesteatoma, revision surgery, and follow-up losses were excluded. The patients were further divided into two cohorts: a pediatric group (<16 years old) and an adult group (>16 years old). The results were compared between them. RESULTS 134 patients fulfilled the inclusion criteria, 27 were pediatric, and 107 adult patients. We found a significant difference in supratubal recess, with higher rates of extension to this location in the pediatric group. Also in the pediatric cohort, COMC was accompanied by malleus erosion in a higher frequency, with a significant difference from adults; it also presented in higher stages of the disease according to EAONO/JOS classification. We found no differences in hearing gain post-operatively. Moreover, we found that age younger than 16 years was an independent risk factor for relapse with time. DISCUSSION AND CONCLUSIONS according to our data, cholesteatoma in pediatric age has a more aggressive and extensive nature than in adults, and age younger than 16-years-old is an independent risk factor for relapse.
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Affiliation(s)
- António Fontes Lima
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal.
| | | | - Ana Sousa Menezes
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | | | - Cátia Azevedo
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | - Miguel Sá Breda
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
| | - Luís Dias
- Department of Otorhinolaryngology, Hospital de Braga, 4715, Braga, Portugal
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Delays in surgery for cholesteatoma due to COVID-19: is there an impact on rates of recidivism and major complications? Eur Arch Otorhinolaryngol 2020; 278:3291-3297. [PMID: 33040233 PMCID: PMC7547560 DOI: 10.1007/s00405-020-06416-7] [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: 08/02/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022]
Abstract
Purpose To evaluate the relationship between the waiting time for surgery, and cholesteatoma recidivism rates and major complications. The secondary aims were to identify any other prognostic factors for cholesteatoma recidivism. Methods A retrospective single-centre study of 312 patients who underwent cholesteatoma surgery under the care of a single-surgeon, between 2004 and 2018, was performed. Waiting times for surgery were categorised into ≤ 90 days, 91–180 days, 181–270 days and > 271 days. The outcome measures were cholesteatoma recidivism and major complications (facial nerve palsy or intracranial complications). Results The mean age was 36.1 years ± 21.5 with 242 adults (77.6%) and 70 children (22.4%). The mean waiting time for surgery was 126.2 days (4.1 months) ± 96.0 days and the overall rate of recidivism was 11.2% (35/312 patients). No instances of facial nerve palsy or intracranial complications were identified. Rates of recidivism by waiting time for surgery were: 15.3% for 118 patients who waited ≤ 90 days, 9.7% for 134 patients who waited 91–180 days, 6.7% for 30 patients who waited 181–270 days and 4.3% for 23 patients who waited > 271 days. There was no significant difference amongst the different waiting time groups for rates of recidivism (p = 0.266). Conclusion Increased waiting times for cholesteatoma surgery do not appear to be associated with increased rates of recidivism or major complications. Clinical judgement will always be required for complicated disease or patients with additional risk factors. The other prognostic factors for recidivism identified in this study were age (< 15 years) and congenital cholesteatoma. Electronic supplementary material The online version of this article (10.1007/s00405-020-06416-7) contains supplementary material, which is available to authorized users.
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Extensive qPCR analysis reveals altered gene expression in middle ear mucosa from cholesteatoma patients. PLoS One 2020; 15:e0239161. [PMID: 32915926 PMCID: PMC7485814 DOI: 10.1371/journal.pone.0239161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
The middle ear is a small and hard to reach compartment, limiting the amount of tissue that can be extracted and the possibilities for studying the molecular mechanisms behind diseases like cholesteatoma. In this paper 14 reference gene candidates were evaluated in the middle ear mucosa of cholesteatoma patients and two different control tissues. ACTB and GAPDH were shown to be the optimal genes for the normalisation of target gene expression when investigating middle ear mucosa in multiplex qPCR analysis. Validation of reference genes using c-MYC expression confirmed the suitability of ACTB and GAPDH as reference genes and showed an upregulation of c-MYC in middle ear mucosa during cholesteatoma. The occurrence of participants of the innate immunity, TLR2 and TLR4, were analysed in order to compare healthy middle ear mucosa to cholesteatoma. Analysis of TLR2 and TLR4 showed variable results depending on control tissue used, highlighting the importance of selecting relevant control tissue when investigating causes for disease. It is our belief that a consensus regarding reference genes and control tissue will contribute to the comparability and reproducibility of studies within the field.
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