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Chen X, Tian J, Wen J, Pan J, Wang Y, Zhang C. Imaging findings of isolated congenital middle ear malformation on high-resolution computed tomography. Neuroradiology 2024:10.1007/s00234-024-03465-1. [PMID: 39297952 DOI: 10.1007/s00234-024-03465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 09/05/2024] [Indexed: 09/21/2024]
Abstract
PURPOSE This study aims to analyze the imaging features of isolated congenital middle ear malformation (CMEM) on high-resolution computed tomography (HRCT). METHODS We retrospectively collected patients with surgically confirmed diagnosis of isolated CMEM in our hospital between January 2018 and June 2023. All patients underwent HRCT before surgery. The preoperative imaging findings were analyzed by neuroradiologists with full knowledge of the intraoperative findings. RESULTS 37 patients were included in this study, including 25 males and 12 females, with a median age of 16 years. A total of 44 ears underwent surgery. The most commonly affected structures were incudostapedial joint, incus long process, and stapes superstructure, followed by stapes footplate, oval window, incudomalleolar join, tympanic segment of the facial nerve canal, incus body, incus short process and malleus. All incus defect/hypoplasia/malposition, stapes superstructure deformity, malleus deformity, incudostapedial joint discontinuity, and facial nerve canal malposition/abnormal bifurcation could be observed on HRCT. Additionally, 96.0% of stapes superstructure defect, 85.7% of oval window atresia, and 41.7% of incudomalleolar joint fusion, could be visualized on HRCT. HRCT could not show ossicular soft tissue pseudo-connection and stapes footplate fixation. CONCLUSIONS Preoperative HRCT is an important tool for diagnosing isolated CMEM. The advantages of HRCT lie in its ability to detect ossicular defects/deformities, incudostapedial joint discontinuity, oval window atresia, and facial nerve abnormalities. However, it has a low detection rate for incudomalleolar joint fusion and cannot show ossicular soft tissue pseudo-connection and stapes footplate fixation.
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Affiliation(s)
- Xiaoxi Chen
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiajie Tian
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jing Wen
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jiayu Pan
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yang Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chunlin Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Fukuda A, Morita S, Hoshino K, Fujiwara K, Nakamaru Y, Homma A. Validity of endoscopic ossiculoplasty immediately after its introduction for ossicular chain disruption. BMC Surg 2024; 24:149. [PMID: 38745291 PMCID: PMC11091995 DOI: 10.1186/s12893-024-02445-9] [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: 03/12/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Transcanal endoscopic ear surgery (TEES) reportedly requires a long learning curve and may be associated with more complications and longer operative times than microscopic ear surgery (MES). In this study, we aimed to examine the usefulness and validity of TEES for ossicular chain disruption in the early stages of its introduction in our institution. METHODS TEES was performed on 11 ears (10 with congenital ossicular chain discontinuity and 1 with traumatic ossicular chain dislocation), and MES was performed with a retroauricular incision on 18 ears (6 with congenital ossicular chain discontinuity and 12 with traumatic ossicular chain dislocation) in a tertiary referral center. Postoperative hearing results, operative times, and postoperative hospital length of stay were retrospectively reviewed. The Mann-Whitney U test and Fisher's exact test was performed to compare variables between the TEES and MES groups. Pre- and postoperative air- and bone-conduction thresholds and the air-bone gap of each group were compared using the Wilcoxon signed-rank test. The Mann-Whitney U test and Wilcoxon signed-rank was performed to compare the pre- and postoperative air-bone gaps between the diagnoses. RESULTS No significant differences in the postoperative air-conduction thresholds, bone-conduction thresholds, air-bone gaps, or incidence of air-bone gap ≤ 20 dB were observed between the TEES and MES groups. The air-conduction thresholds and air-bone gaps of the TEES group significantly improved postoperatively. The air-conduction thresholds and air-bone gaps of the MES group also significantly improved postoperatively. No significant difference was observed in the operative times between the groups (TEES group: median, 80 min; MES group: median, 85.5 min). The TEES group had a significantly shorter postoperative hospital stay (median, 2 days) than the MES group (median, 7.5 days). CONCLUSIONS TEES was considered appropriate for the treatment of ossicular chain disruption, even immediately after its introduction at our institution. For expert microscopic ear surgeons, ossicular chain disruption may be considered a suitable indication for the introduction of TEES.
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Affiliation(s)
- Atsushi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan.
| | - Shinya Morita
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan
| | - Kimiko Hoshino
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan
| | - Keishi Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Hokkaido, Sapporo, 060-8638, Japan
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Kobayashi T, Kuzume M, Ito H, Komori M, Hyodo M. Surgical results of 29 ears with congenital middle ear anomalies; Microscopic vs. endoscopic ear surgery. Auris Nasus Larynx 2024; 51:412-416. [PMID: 37648585 DOI: 10.1016/j.anl.2023.08.008] [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: 03/06/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Although congenital middle ear anomalies include various types of ossicular anomalies, all of these can be treated by ossiculoplasty or stapes surgery. Transcanal endoscopic ear surgery (TEES) is a minimally invasive surgical method for middle ear disease with an excellent surgical view that has been widely adopted worldwide. To determine the efficacy of TEES for middle ear anomalies, we describe the surgical results and compare the hearing outcomes between patients treated by TEES and microscopic ear surgery (MES). METHODS A total of 39 ears with congenital middle ear anomalies were treated surgically at the University Hospital of Kochi Medical School between January 2011 and December 2021. In total, 29 ears of 23 patients were included in the study. Demographics, type of anomaly, surgical methods, pre- and postoperative hearing thresholds, and surgical complications were investigated by retrospective chart review. RESULTS Of the 29 ears, 11 were treated by MES and 18 were treated by TEES. There were no differences in sex, age, preoperative hearing thresholds, or rate of stapes surgery between the two groups. The mean air-bone gap improvement was 20.6 dB in the MES group and 28.8 dB in the TEES group; these values were not significantly different. The median operation time was not significantly different between the MES and TEES groups (125 and 130 min, respectively). The improvements of air conduction in class 1 and 2 (stapes surgery) and class 3 (ossiculoplasty) cases were also not different between the groups. CONCLUSIONS TEES achieved comparable hearing outcomes to MES without postauricular or endaural incisions. Further, class 1 and 2 anomalies demonstrated hearing improvement similar to class 3 without major complications. Since the surgical field limited around the ossicular chain, coupled with the fact that the middle ear anomaly itself does not exhibit inflammation leading to unfavorable bleeding, TEES is a feasible surgical procedure for all types of congenital ossicular anomalies.
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Affiliation(s)
- Taisuke Kobayashi
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN.
| | - Mayu Kuzume
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Hiroaki Ito
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, JAPAN
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Furukawa T, Goto T, Abe Y, Sugiyama M, Ito T, Kubota T, Matsui H, Futai K, Kakehata S. The use of basic fibroblast growth factor to treat intractable Bell's palsy administered via transcanal endoscopic ear surgery. Am J Otolaryngol 2024; 45:104020. [PMID: 37604093 DOI: 10.1016/j.amjoto.2023.104020] [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: 03/26/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Facial nerve decompression surgery is an invasive procedure which has hitherto been the main option for patients with severe intractable Bell's palsy which is resistant to drug treatment. We have developed a new salvage treatment for such patients by using minimally invasive transcanal endoscopic ear surgery (TEES) to deliver the biological regenerative agent, basic fibroblast growth factor (bFGF), to the damaged facial nerve. MATERIALS AND METHODS An endoscopic salvage treatment group was studied prospectively and was made up of severe intractable Bell's palsy patients who did not respond to high dose steroid treatment and had an ENoG value of 5 % or less. This surgery group was retrospectively compared to a similar control group who had received high dose steroid only. RESULTS Complete recovery to House-Brackmann (HB) Grade I was achieved by 44.8 % of the endoscopic salvage treatment group which was significantly higher than the 21.2 % of the control group at one-year follow up. Patients with an ENoG value of 1 % to 5 % exhibited a significantly higher complete recovery rate of 71.4 % in the endoscopic salvage treatment group than the 28.6 % of the control group. In addition, no complications were observed including hearing loss. CONCLUSIONS bFGF delivered via TEES shows considerable promise as a new salvage treatment of severe intractable Bell's palsy that is resistant to high dose steroid treatment without the risks presented by facial nerve decompression surgery.
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Affiliation(s)
- Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan.
| | - Takanari Goto
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Yasuhiro Abe
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Motoyasu Sugiyama
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Toshinori Kubota
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Hirooki Matsui
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Kazunori Futai
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University, Faculty of Medicine, Japan
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Yeon EK, Son HO, Sung HJ, Choi JW. Bilateral Congenital Ossicular Anomalies: Are the Anomalies Symmetric for Both Ears? Otolaryngol Head Neck Surg 2023; 169:1028-1034. [PMID: 37003293 DOI: 10.1002/ohn.341] [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: 01/20/2023] [Revised: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To evaluate whether bilateral congenital ossicular anomalies (COAs) differ regarding ossicular anomalies and hearing loss severities between the ears of the individual. STUDY DESIGN Retrospective case review. SETTING Tertiary referral academic center. METHODS Between March 2012 and December 2022, 7 consecutive patients (14 ears) with surgically confirmed bilateral COAs were included in the study. Preoperative pure-tone thresholds, COA classification according to the Teunissen and Cremers system, surgical procedures, and postoperative audiometric results were compared between the 2 ears of each patient. RESULTS The median age of the patients was 11.5 (range: 6-25) years. Both ears of each patient were categorized based on the same classification. Three patients possessed class III COAs and the other 4 had class I COAs. The interaural differences in preoperative bone and air conduction thresholds were within 15 dB for all patients. Differences in postoperative air-bone gaps between ears were not statistically significant. The surgical procedures required for ossicular reconstruction were almost identical for both ears. CONCLUSION The severity of ossicular abnormalities and hearing loss in patients with bilateral COAs were symmetrical between ears, thereby enabling prediction of the characteristics of the contralateral ear based on the findings observed in 1 ear. These symmetric clinical features can aid surgeons when operating on the contralateral ear.
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Affiliation(s)
- Eun-Kyeong Yeon
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hyo One Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hanwool John Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jin Woong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
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Henkemans SE, Rovers J, Thomeer HGXM. Surgical outcome in class 4 congenital anomalies of the ossicular chain: a systematic review of the literature. Eur Arch Otorhinolaryngol 2023; 280:4327-4337. [PMID: 37410147 PMCID: PMC10477222 DOI: 10.1007/s00405-023-08091-w] [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: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia. DATA SOURCES Pubmed/Medline, Embase and Cochrane library. REVIEW METHODS Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss. RESULTS Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and - 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0-33.3% of ears, and recurrence of hearing loss occurred in 0-66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss. CONCLUSION Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL. LEVEL OF EVIDENCE 2c.
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Affiliation(s)
- S E Henkemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands
| | - J Rovers
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands
| | - H G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands.
- Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Shi L, Chen S, Li R, Huang Y. Transcanal endoscopic management of isolated congenital middle ear malformations. Acta Otolaryngol 2023; 143:12-18. [PMID: 36661444 DOI: 10.1080/00016489.2023.2168051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND A few studies have reported transcanal endoscopic management of isolated congenital middle ear malformations (CMEMs). OBJECTIVE The purpose of this study is to describe our surgical experience in endoscopic ear surgery for isolated CMEMs and evaluate the surgical effect of hearing reconstruction. METHODS From January 2017 to January 2022, a retrospective study was performed on 36 patients (37 ears) with isolated CMEMs who all underwent endoscopic surgery. Demographic data, high-resolution computed tomography (HRCT) findings, intraoperative findings, surgical management and audiometric data were recorded. RESULTS Anomalies were categorized according to the Teunissen and Cremers classification system: 8 ears were categorized as class I, 8 ears as class II, 19 ears as class III and 2 ears as class IV. The air conduction pure tone average (AC-PTA) of 37 cases was 61.5 ± 8.6 dB preoperatively and 29.6 ± 6.9 dB postoperatively (p < 0.001). The mean preoperative air-bone gap (ABG) significantly decreased from 43.1 ± 8.7 dB to 12.8 ± 5.5 dB postoperatively. 36 of 37 cases (97%) met the criteria for successful operation. CONCLUSION Isolated CMEMs are mainly manifested as aplasia of the stapes' superstructure and dysplasia of the long process of the incus. Transcanal endoscopic surgery seems a safe technique for the management of isolated CMEMs.
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Affiliation(s)
- Licai Shi
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Shuainan Chen
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Rujie Li
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yideng Huang
- Department of Otolaryngology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Tu LJ, Fina M, Golub JS, Kazahaya K, Quesnel AM, Tawfik KO, Cohen MS. Current Trends in Endoscopic Ear Surgery. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e023. [PMID: 38516579 PMCID: PMC10950159 DOI: 10.1097/ono.0000000000000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 03/23/2024]
Affiliation(s)
- Leona J. Tu
- Drexel University College of Medicine, Philadelphia, PA
| | - Manuela Fina
- Department of Otolaryngology—Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Justin S. Golub
- Department of Otolaryngology—Head and Neck Surgery, Valegos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Kareem O. Tawfik
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Audiometric Outcomes Comparing Endoscopic Versus Microscopic Ossiculoplasty. Otol Neurotol 2022; 43:820-826. [PMID: 35802898 DOI: 10.1097/mao.0000000000003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess endoscopic and microscopic ossiculoplasty audiometric outcomes. STUDY DESIGN Retrospective review. SETTING Tertiary academic center. PATIENTS Adult patients who underwent ossiculoplasty with either partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) from 2010 to 2019 with at least 1 year of audiometric follow-up were included. INTERVENTIONS Endoscopic or microscopic ossiculoplasty. MAIN OUTCOME MEASURES Postoperative air-bone gap (ABG) after at least 1 year. RESULTS A total of 198 patients, 53.5% female, and a median age of 47.5 years, met inclusion criteria. 64.1% of patients were reconstructed with a PORP, and 31.8% were reconstructed using an endoscopic approach. The median audiometric follow-up was 27 months. The median postoperative ABG was 16.9 dB overall, 15.6 dB for PORP reconstruction, and 19.4 dB for TORP reconstruction (PORP versus TORP, p = 0.002). For TORP reconstructions, the median ABG for both endoscopic and microscopic TORP was 19.4 dB (p = 0.92). For PORP reconstructions, the median ABG for endoscopic PORP was 12.3 dB compared with 16.3 dB for microscopic PORP (p = 0.02). Using multivariate linear regression to predict postoperative PORP ABG, and controlling for age, prior ossiculoplasty, middle ear mucosal disease (granulation, fibrosis, polyposis), middle ear atelectasis, myringitis, contralateral middle ear disease, and use of byte prostheses, endoscopic PORP reconstruction was associated with improvement in ABG over the microscopic approach by 4.4 dB (p = 0.04). CONCLUSIONS For PORP ossiculoplasty procedures, endoscopic ossiculoplasty is associated with improved postoperative ABG compared with microscopic ossiculoplasty.
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Yang Q, Wang B, Zhang J, Liu H, Xu M, Zhang W. Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2022; 279:4801-4807. [PMID: 35122510 PMCID: PMC9474537 DOI: 10.1007/s00405-022-07273-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND To compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients. METHODS A retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears). RESULTS The successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air-bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05). CONCLUSION TEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.
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Affiliation(s)
- Qimei Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Bing Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Jin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Hui Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Min Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Wen Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Yoshida A, Hosoya M, Kanzaki S, Fujioka M, Ozawa H. Transcanal endoscopic ear surgery for management of ossicular malformation: clinical outcomes of 17 cases. Acta Otolaryngol 2022; 142:154-160. [PMID: 35232332 DOI: 10.1080/00016489.2022.2039406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In recent years, transcanal endoscopic ear surgery (TEES) is known as an innovative and minimally invasive surgery. AIMS To clarify the usefulness of TEES for the ossicular malformation, we performed a retrospective study. MATERIAL AND METHODS We examined cases of ossicular malformation performed using TEES at our hospital between April 2015 and April 2020. RESULTS The hearing level results were countable for 16 cases. Post-operative hearing levels were significantly improved. Transient nausea, tongue paralysis, and taste disorders were observed; however, no other complications were observed. In 2015-2018, some of the cases required the assistance of a surgical microscope. In contrast, all the cases were performed by TEES after 2019 using a powered device to curve the canal. CONCLUSIONS AND SIGNIFICANCE TEES requires considerable training, and the sensation of depth is difficult to acquire. However, this less invasive method is also helpful for ossicular malformation cases.
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Affiliation(s)
- Alyssa Yoshida
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Sho Kanzaki
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masato Fujioka
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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Sheppard SC, Caversaccio MD, Anschuetz L. Endoscopic and Robotic Stapes Surgery: Review with Emphasis on Recent Surgical Refinements. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
Stapes surgery has been established as the gold standard for surgical treatment of conductive hearing loss in otosclerosis. Excellent outcomes with very low complication rate are reported for this surgery. Recent advances to improve surgical outcome have modified the surgical technique with endoscopes, and recent studies report development of robotical assistance. This article reviews the use of endoscopes and robotical assistance for stapes surgery.
Recent Findings
While different robotic models have been developed, 2 models for stapes surgery have been used in the clinical setting. These can be used concomitant to an endoscope or microscope. Endoscopes are used on a regular base regarding stapes surgery with similar outcomes as microscopes. Endoscopic stapes surgery shows similar audiological results to microscopic technique with an advantage of less postoperative dysgeusia and pain. Its utility in cases of revision surgery or malformation is emphasized.
Summary
Endoscopic stapes surgery is used on a regular basis with excellent outcomes similar to the microscopic approach, while reducing surgical morbidity. Robotic technology is increasingly being developed in the experimental setting, and first applications are reported in its clinical use.
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14
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Bozzato A, Flockerzi V. [Endoscopically guided reconstruction of the ossicular chain-an introduction]. HNO 2021; 69:797-802. [PMID: 34125235 DOI: 10.1007/s00106-021-01062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
The term "endoscopic ossiculoplasty" refers to surgical methods with the intention to reconstruct the ossicular chain using endoscopic vision. Apart from malformations and injuries, inflammatory processes cause the majority of indications for ossicular reconstruction. This article offers a commented overview of current literature and preliminary personal experience.
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Affiliation(s)
- Alessandro Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland.
| | - Veronika Flockerzi
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Straße, Gebäude 6, 66421, Homburg/Saar, Deutschland
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15
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Henkemans SE, Smit AL, Stokroos RJ, Thomeer HGXM. Congenital Anomalies of the Ossicular Chain: Surgical and Audiological Outcomes. Ann Otol Rhinol Laryngol 2021; 131:388-396. [PMID: 34116598 PMCID: PMC8899814 DOI: 10.1177/00034894211025405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: In this study, we aim to analyze audiometric outcomes of middle ear surgery
in patients with congenital middle ear anomalies. Methods: In this single center retrospective cohort study, audiological outcomes were
extracted from patient files. Patients with a congenital middle ear anomaly
treated surgically in a tertiary referral center between June 2015 and
December 2020 were included. Pre- and postoperative short- and long-term
audiometric data (at ≥3 and ≥10 months respectively) were compared to
analyze hearing outcomes. Results: Eighteen ears (15 patients) were treated surgically with an exploratory
tympanotomy. At short term follow up statistically significant improvements
in air conduction thresholds and air-bone gaps were found. Hearing improved
in 94.4% (17/18) of operated ears. Successful outcome, defined as an
air-bone gap closure to within 20 dB after surgery, was reached in 44.4%
(8/18). Serviceable hearing (air conduction ≤30 dB) was reached in 55.6%
(10/18). Negative outcome (any significant deterioration in hearing)
occurred in 1 patient: in this ear otitis media occurred during the
postoperative course. At long term follow up, available for 50% of the
cohort, hearing remained stable in 5 ears, improved in 1 ear and
deteriorated in 3, all of which underwent revision surgery. Sensorineural
hearing loss due to surgery, or other complications, were not
encountered. Conclusion: middle ear surgery was found to be an effective treatment option to improve
hearing in this cohort of patients with congenital middle ear anomalies.
Surgical goals of obtained gain in air conduction thresholds and serviceable
hearing levels were met by most patients without the occurrence of any
iatrogenic sensorineural hearing loss.
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Affiliation(s)
- Sara E Henkemans
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.,Brain Centre Rudolf Magnus, University Medical Centre Utrecht, The Netherlands
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Ito T, Furukawa T, Ohshima S, Takahashi K, Takata Y, Furukawa M, Hiraumi H, Yamauchi D, Yuasa Y, Goto S, Sasaki A, Koizumi K, Otsuki K, Imaizumi M. Multicenter Study of Congenital Middle Ear Anomalies. Report on 246 Ears. Laryngoscope 2021; 131:E2323-E2328. [PMID: 33645732 DOI: 10.1002/lary.29482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Congenital middle ear anomalies represent a relatively rare condition. This study aimed to describe the characteristics and the surgical outcomes for patients with middle ear anomalies. METHODS A multicenter study was conducted of consecutive patients with congenital middle ear anomalies who underwent primary surgical treatment between January 2008 and December 2017. Demographics, surgical procedures, and audiometric data were registered into the institutional database. Hearing changes and postoperative air-bone gap (ABG) were evaluated 1 year after surgery. RESULTS A total of 246 patients (246 ears) (median age: 14 years, range: 4-75 years old) were included in this study. Anomalies were subdivided using the Teunissen and Cremers classification: 53 ears (22%) were categorized as class I, comprising only stapes ankylosis; 35 ears (14%) as class II, having ossicular chain anomalies with stapes ankylosis; 139 ears (57%) as class III, having ossicular chain anomalies with a mobile stapes-footplate; and 19 ears (8%) as class IV, with aplasia of the oval window. Evaluation of hearing outcomes for 198 ears with more than 1 year of follow-up revealed that good postoperative ABG (≤20 dB) was achieved in 82% of class I, 68% of class II, 74% of class III, and 23% of class IV anomalies. The postoperative ABG in class IV was significantly worse than in class I (P < .001) or class III (P < .01). CONCLUSIONS This study demonstrated that class III anomalies comprised the majority of middle ear anomalies and surgical outcomes for class IV anomalies are unfavorable. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E2323-E2328, 2021.
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Affiliation(s)
- Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yusuke Takata
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayuki Furukawa
- Department of Otorhinolaryngology, Juntendo Urayasu Hospital, Chiba, Japan
| | - Harukazu Hiraumi
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, School of Medicine, Shiwa, Japan
| | - Daisuke Yamauchi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Yuasa
- Sendai Ear Surgicenter, Sendai, Japan
| | - Shinichi Goto
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akira Sasaki
- Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koh Koizumi
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Akita University, Akita, Japan
| | - Koshi Otsuki
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
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17
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Sun H, Qiao Y, Chen N, Yang H, Gao Z, Shang Y. Delayed-Onset NOG Gene-Related Syndromic Conductive Deafness: A Case Report. EAR, NOSE & THROAT JOURNAL 2020; 100:333S-336S. [PMID: 32791904 DOI: 10.1177/0145561320944639] [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] Open
Abstract
We report a 6-year-old girl with progressive bilateral conductive hearing loss for 2 years. She passed the newborn hearing screening conducted with otoacoustic emissions testing and had a normal development of speech and language, which indicated that her deafness was delayed-onset. She also had congenital proximal interphalangeal joints. Proximal symphalangism was confirmed by genetic testing (NOG gene: c.406C > T, p.R136C). Bilateral stapes ankyloses were proved by surgery and her hearing was improved after stapedotomy by over 30 dB. Besides, this case should remind clinicians to carefully distinguish NOG gene-related deafness from congenital ossicular malformation and pediatric otosclerosis.
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Affiliation(s)
- Huiying Sun
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yufei Qiao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Chen
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Otorhinolaryngology, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Hua Yang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Shang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, 12381Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Measurement of the Pediatric and Adult Osseous External Auditory Canal: Implications for Transcanal Endoscopic Ear Surgery. Otol Neurotol 2020; 41:e712-e719. [DOI: 10.1097/mao.0000000000002653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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