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Marchioni D, Bisi N, Rubini A. Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results. ACTA OTORRINOLARINGOLOGICA (ENGLISH EDITION) 2023; 74:101-107. [PMID: 37005039 DOI: 10.1016/j.otoeng.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/05/2022] [Indexed: 04/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES The aim of the present study is the assessment of exclusive endoscopic ear surgery for the management of primarily acquired pars tensa cholesteatoma, which is commonly linked to the failure of the Eustachian tube leading to the formation of retraction pockets. MATERIALS AND METHODS Patients suffering from primarily acquired pars tensa cholesteatoma, who underwent primary surgery in our clinic, between 2014 and 2018 were included in this retrospective study. The disease was classified according to the EAONO/JOS system. Exclusive endoscopic ear surgery was performed for patients without mastoid involvement, while a microscopic-endoscopic tympanoplasty was carried out in case of mastoid extension. We assessed the recidivism rate during the follow-up. RESULTS Cholesteatomas belonged to stage I in 28% of cases, to stage II in 68% and only one patient was stage III. Only a portion of the pars tensa was involved in 13 instances, the whole pars tensa in 3 and both the tensa and the flaccida in 9. 17 out of 25 patients underwent exclusive endoscopic ear surgery and 8 needed a combined approach. We discovered 1 recurrence and 6 residual diseases. CONCLUSIONS With only one case of recurrence in our series, we showed how pars tensa cholesteatoma cannot be exclusively explained through Eustachian tube dysfunction, but also through a ventilation blockage between the Eustachian tube and other mesotympanic areas due to the formation of intratympanic folds. Endoscopic ear surgery proved highly effective in the control of recurrences and it should be considered the treatment of choice.
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Motegi M, Yamamoto Y, Nakazawa T, Tada T, Hirabayashi M, Kurihara S, Takahashi M, Sampei S, Yamamoto K, Sakurai Y, Kojima H. Radiological and audiological prediction for hearing outcome in cholesteatoma recidivism surgery. Eur Arch Otorhinolaryngol 2022; 280:2715-2724. [PMID: 36436081 DOI: 10.1007/s00405-022-07760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE In cholesteatoma recidivism, achieving satisfactory hearing outcome after revision surgery remains challenging. The presence of concomitant recidivism pathology or related anatomical abnormalities can impact revision reconstruction of the sound transmission system. The current study aimed to identify prognostic factors affecting hearing outcomes after surgery for cholesteatoma recidivism. METHODS This retrospective cohort study included consecutive patients whose ears required initial surgery for recidivism between January 2016 and December 2021. Patients followed up for < 6 months and those not indicated for ossiculoplasty were excluded. The impact of preoperative otoscopic findings, computed tomography (CT) features, and hearing levels on the prediction of satisfactory hearing (postoperative air-bone gap [ABG] ≤ 20 dB) was evaluated using univariate and multivariate logistic regression analyses. RESULTS Overall, 102 patients were included, with a mean follow-up of 24.8 months. Multivariate logistic regression analysis revealed the following independent predictive factors for satisfactory hearing: presence of aeration in the tympanic cavity (odds ratio [OR] [95% confidence interval {CI}]: 13.287 [1.113-158.604], p = 0.0409), absence of soft-tissue density occupying the oval window (OR [95% CI]: 13.445 [3.178-56.887], p = 0.0040), and ≤ 22.5 dB preoperative ABG in four-frequency average (OR [95% CI]: 9.339 [2.026-43.050], p = 0.0042). CONCLUSIONS For cholesteatoma recidivism, reliable preoperative prediction based on CT and ABG would facilitate decision-making regarding the probability of efficient revision ossiculoplasty or appropriate preoperative counseling, including early hearing rehabilitation using hearing aids or implementation of simultaneous implantable hearing equipment during surgery for recidivism.
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Affiliation(s)
- Masaomi Motegi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Takara Nakazawa
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Takeshi Tada
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Motoki Hirabayashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Sayaka Sampei
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Yuika Sakurai
- 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
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Marchioni D, Bisi N, Rubini A. Endoscopic transcanal surgery of pars tensa cholesteatoma: Preliminary results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hardcastle T, McKay-Davies I, Neeff M. Petrous apex pneumatisation in children: a radiological study. J Laryngol Otol 2020; 134:1-6. [PMID: 32830634 DOI: 10.1017/s0022215120001681] [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: 11/05/2022]
Abstract
OBJECTIVE This study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease. METHODS Computed tomography head scans from 1700 patients aged 0-16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex. RESULTS Petrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule. CONCLUSION In children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.
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Affiliation(s)
- T Hardcastle
- Department of ORL, Auckland City Hospital, New Zealand
| | - I McKay-Davies
- ENT Department, Maidstone and Tunbridge Wells NHS Trust, UK
| | - M Neeff
- Department of ORL, Auckland City Hospital, New Zealand
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Shewel Y, Bassiouny M, Ebrahim M. Endoscopic Assessment of the Isthmus Tympanicum and Tensor Tympani Fold and their Relationship with Mastoid Pneumatization in Chronic Otitis Media. J Int Adv Otol 2020; 16:227-233. [PMID: 32209517 DOI: 10.5152/iao.2020.7507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To endoscopically evaluate the patency of the isthmus tympanicum and integrity of the tensor tympani fold as routes of ventilation of the attic and mastoid in chronic otitis media (COM) and to assess their effects on mastoid pneumatization. MATERIALS AND METHODS Sixty patients with COM were categorized into two groups: (1) Group A: 36 patients with tympanic membrane perforation (2) Group B: 24 patients with limited attic disease of whom 14 patients had attic retraction pockets and 10 with limited attic cholesteatoma. A multislice computed tomography scan of the temporal bone was performed for each patient to assess the degree of mastoid pneumatization. Notably, either myringoplasty or tympanomastoid surgery was performed in all patients. An endoscope was inserted into the middle ear for evaluation of the isthmus tympanicum and tensor fold area. RESULTS The isthmus tympanicum was patent in most ears (83.3%) of group A, whereas it was blocked in most ears (83.3%) of group B. The tensor fold was complete in 77.8% of ears in group A and 83.3% of ears in group B. It was observed that 94.1% of ears with patent isthmus in both groups had normal mastoid pneumatization and 5.9% of ears had poorly pneumatized mastoid. By contrast, 7.7% of ears with blocked isthmus tympanicum had normal mastoid pneumatization and 92.3% had poor mastoid pneumatization. Normal mastoid pneumatization was observed in 50% of ears in both groups with complete tensor fold, and 83.3% of ears with an incomplete tensor fold. CONCLUSION A significant correlation was observed between COM with limited attic disease and obstruction of the isthmus tympanicum. Obstruction of isthmus tympanicum was associated with poor mastoid pneumatization. Furthermore, an incomplete tensor fold was associated with well pneumatized mastoid.
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Affiliation(s)
- Yasser Shewel
- Department of Otorhinolaryngology-Head and Neck Surgery, Alexandria University, Alexandria, Egypt
| | - Mokhtar Bassiouny
- Department of Otorhinolaryngology-Head and Neck Surgery, Alexandria University, Alexandria, Egypt
| | - Mohammad Ebrahim
- Department of Otorhinolaryngology-Head and Neck Surgery, Alexandria University, Alexandria, Egypt
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Motegi M, Yamamoto Y, Tada T, Takahashi M, Sampei S, Sano H, Morino T, Komori M, Miura M, Yamamoto K, Yaguchi Y, Sakurai Y, Kojima H. Clinical Characteristics of Pars Tensa Cholesteatoma: A Comparative Study of Area-Based Classification Systems Proposed by the Japanese Otological Society and the European Academy of Otology - Neuro-Otology. J Int Adv Otol 2020; 15:184-188. [PMID: 31287432 DOI: 10.5152/iao.2019.6349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical characteristics of extent patterns in pars tensa cholesteatoma. MATERIALS AND METHODS This was a retrospective chart review. Forty-four patients with pars tensa cholesteatoma who underwent primary surgery at a tertiary academic medical center were included. The main outcomes measured were sex, age, clinical background, and stage classification of pars tensa cholesteatoma (including the extent of cholesteatoma and involvement of the sinus tympani) according to two staging classifications: criteria advocated by the Japanese Otological Society (JOS) and those advocated by the European Academy of Otology and Neuro-Otology (EAONO)/JOS joint consensus statements. RESULTS The mean patient age ± standard deviation was 38.4±19.6 years. The patients comprised 19 men and 25 women. According to the JOS classification, 18 ears (40.9%) were classified as stage I, 22 (50.0%) as stage II, and 4 (9.1%) as stage III. According to the EAONO/JOS joint consensus statements, 14 ears (31.8%) were classified as stage I, 26 (59.1%) as stage II, and 4 (9.1%) as stage III. Fourteen ears (31.8%) demonstrated involvement of the sinus tympani. Four ears (9.1%) that were originally categorized as stage I cholesteatoma by the JOS criteria showed sinus tympani invasion and were subsequently categorized as stage II according to the EAONO/JOS criteria. CONCLUSION We determined the clinical characteristics of pars tensa cholesteatoma based on the novel and well-defined classification criteria. Further studies including long-term outcomes are necessary to demonstrate the clinical relevance of the discrepancy between the two criteria with respect to involvement of the sinus tympani.
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Affiliation(s)
- Masaomi Motegi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Takeshi Tada
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Sayaka Sampei
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Sano
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Tsunetaro Morino
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Manabu Komori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Miura
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Yaguchi
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yuika Sakurai
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Dexian Tan A, Ng JH, Lim SA, Low DYM, Yuen HW. Classification of Temporal Bone Pneumatization on High-Resolution Computed Tomography: Prevalence Patterns and Implications. Otolaryngol Head Neck Surg 2018; 159:743-749. [PMID: 29807479 DOI: 10.1177/0194599818778268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The degree of pneumatization of the temporal bone has implications in the pathophysiology and surgical considerations of many temporal bone disorders. This study aims to identify common pneumatization patterns in the petrous apex, mastoid, and infralabyrinthine compartments of the temporal bone. Variables associated with temporal bone pneumatization were also identified. Study Design Case series with chart review. Setting Single tertiary hospital. Subjects and Methods In total, 299 high-resolution computed tomography scans of the temporal bone performed on patients between 2013 and 2016 were reviewed. Only normal temporal bone scans in patients aged 13 years and older were included. Previously published grading systems were used to classify pneumatization patterns in the petrous apex, mastoid, and infralabyrinthine region. Results The most common pneumatization pattern in the petrous apex was group 2 (less than half of the petrous apex medial to the labyrinth is pneumatized), that in the mastoid was group 4 (hyperpneumatization), and that in the infralabyrinthine region was type B (limited pneumatization), at 54.8%, 55.4%, and 76.0% of patients, respectively. Patients with increased pneumatization of 1 temporal bone compartment tended to have increased pneumatization of the same compartment on the contralateral side and the other compartments on the ipsilateral side ( P < .05). Younger age ( P < .001) and male sex ( P = .001) were associated with increased pneumatization in the petrous apex and infralabyrinthine compartments. Conclusion The degree of temporal bone pneumatization varies among the different compartments. Age and sex have a significant association with the degree of pneumatization of the petrous apex and infralabyrinthine compartment.
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Affiliation(s)
- Arthur Dexian Tan
- 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Hui Ng
- 2 Department of Otorhinolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore
| | - Su Ann Lim
- 2 Department of Otorhinolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore
| | - David Yong-Ming Low
- 2 Department of Otorhinolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore
| | - Heng Wai Yuen
- 2 Department of Otorhinolaryngology-Head & Neck Surgery, Changi General Hospital, Singapore
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Alper CM, Luntz M, Takahashi H, Ghadiali SN, Swarts JD, Teixeira MS, Csákányi Z, Yehudai N, Kania R, Poe DS. Panel 2: Anatomy (Eustachian Tube, Middle Ear, and Mastoid-Anatomy, Physiology, Pathophysiology, and Pathogenesis). Otolaryngol Head Neck Surg 2017; 156:S22-S40. [PMID: 28372527 DOI: 10.1177/0194599816647959] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
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Affiliation(s)
- Cuneyt M Alper
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,3 Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michal Luntz
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Haruo Takahashi
- 5 Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Samir N Ghadiali
- 6 Department of Biomedical Engineering, Ohio University, Columbus, Ohio, USA.,7 Department of Internal Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio University, Columbus, Ohio, USA
| | - J Douglas Swarts
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Miriam S Teixeira
- 2 Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Zsuzsanna Csákányi
- 8 Department of Pediatric Otorhinolaryngology, Heim Pal Children's Hospital, Budapest, Hungary
| | - Noam Yehudai
- 4 Department of Otolaryngology Head and Neck Surgery, Bnai Zion Medical Center; Technion-The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Romain Kania
- 9 Department of Otorhinolaryngology-Head and Neck Surgery, Lariboisière Hospital, Diderot University, University Paris Sorbonne, Paris, France
| | - Dennis S Poe
- 10 Department of Otology and Laryngology, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA.,11 Department of Otolaryngology and Communications Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
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Anatomical Factors Influencing Pneumatization of the Petrous Apex. Clin Exp Otorhinolaryngol 2015; 8:339-44. [PMID: 26622951 PMCID: PMC4661248 DOI: 10.3342/ceo.2015.8.4.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/12/2014] [Accepted: 12/01/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Aim of the present study was to define the relationship between petrous apex pneumatization and the nearby major anatomical landmarks using temporal bone computed tomography (CT) images. Methods This retrospective, Institutional Review Board-approved study analyzed CT images of 84 patients that showed normal findings bilaterally. Pneumatization of the petrous apex was classified using two methods. Eight parameters were as follows: angle between the posterior cranial fossa and internal auditory canal, Morimitsu classification of anterior epitympanic space, distance between the carotid canal and jugular bulb, distance between the cochlear modiolus and carotid canal, distance between the tympanic segment and jugular bulb, high jugular bulb, distance between the vertical segment and jugular bulb, and distance between the lateral semicircular canals and middle cranial fossa. Results There was a significant difference in Morimitsu classification of the anterior epitympanic space between the two classification methods. Poorly pneumatic upper petrous apices were distributed uniformly in three types of Morimitsu classification, but more pneumatic upper petrous apices were found more often in anterior type. Lower petrous apex was well pneumatized regardless of the types of anterior epitympanic space, but the largest amount of pneumatization was found more frequently in the anterior type of anterior epitympanic space. Conclusion This study showed that there was no reliable anatomic marker to estimate petrous apex pneumatization and suggests that the pneumatization of the petrous apex may be an independent process from other part of the temporal bone, and may not be influenced by the nearby major anatomical structures in the temporal bone. In this study, the anterior type of anterior epitympanic space was found to be closely related to more well-pneumatized petrous apices, which implies that the anterior saccule of the saccus medius may be the main factor influencing pneumatization of the petrous apex.
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A Comparison of Preoperative Characteristics of Chronic Otitis Media in Down and Non-Down Syndrome. Otol Neurotol 2014; 35:972-5. [DOI: 10.1097/mao.0000000000000464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Differences in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas. Eur Arch Otorhinolaryngol 2013; 271:2171-5. [PMID: 24071859 DOI: 10.1007/s00405-013-2713-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/16/2013] [Indexed: 12/27/2022]
Abstract
This study investigated the difference in clinical characteristics of fallopian canal dehiscence associated with pars flaccida and pars tensa cholesteatomas for the purpose of increasing the preoperative detectability of dehiscence. A total of 189 ears of patients 7-80 years of age (mean 42 years) with pars flaccida cholesteatoma and 63 ears of patients 9-84 years of age (mean 50 years) with pars tensa cholesteatoma were studied. All patients had undergone prior surgical management at our institution from January 2006 to April 2012. The incidence of fallopian canal dehiscence and its location were compared between pars flaccida and pars tensa cholesteatomas. Intraoperative findings of coexistent pathologies, including destruction of the stapes superstructure, labyrinthine fistula, and dural exposure, were compared between the dehiscence and no-dehiscence groups for the two types of cholesteatomas. The incidence of dehiscence was significantly higher in patients with pars tensa cholesteatoma (55.6 %) than in patients with pars flaccida cholesteatoma (26.5 %). Dehiscence located posterior to the cochleariform process occurred slightly more frequently in patients with pars tensa cholesteatoma than in those with pars flaccida cholesteatoma. In patients with pars flaccida cholesteatoma, labyrinthine fistulas and dural exposure were significantly more frequent in the dehiscence group than in the no-dehiscence group. Fallopian canal dehiscence is more frequent in patients with pars tensa cholesteatoma than in those with pars flaccida cholesteatoma. Especially in patients with pars flaccida cholesteatoma, paying special attention to these coexisting pathologies is important to increase preoperative detectability of dehiscence.
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Mann W, Al-Nawas B, Wriedt S, Mann S, Koutsimpelas D. Cholesteatoma of the hypotympanum in a patient with Treacher Collins syndrome. Auris Nasus Larynx 2013; 41:101-4. [PMID: 23860365 DOI: 10.1016/j.anl.2013.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/30/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
In the present article we report a cholesteatoma of the hypotympanum extending to the jugular foramen in a 16-year-old male with Treacher Collins syndrome. Preoperative imaging excluded jugular paraganglioma and set the diagnosis of cholesteatoma. We discuss the operative treatment via a large hypotympanotomy and creation of an open hypotympanic cavity. To the authors' knowledge this is the first description of hypotympanal cholesteatoma with such an extension, being treated through this approach.
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Affiliation(s)
- Wolf Mann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Building 102, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral-, Maxillofacial- and Plastic Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, Building 901, 55131 Mainz, Germany
| | - Susanne Wriedt
- Department of Orthodontics, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, Building 901, 55131 Mainz, Germany
| | - Sophie Mann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Building 102, 55131 Mainz, Germany
| | - Dimitrios Koutsimpelas
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Building 102, 55131 Mainz, Germany.
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Clinical characteristics and surgical benefits and problems of chronic otitis media and middle ear cholesteatoma in elderly patients older than 70 years. Otol Neurotol 2013; 33:1213-7. [PMID: 22801042 DOI: 10.1097/mao.0b013e31825f24ba] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the benefits and problems of tympanoplasty in elderly patients older than 70 years. STUDY DESIGN Retrospective case review. SETTING Referral hospital otolaryngology department. PATIENTS Among 1,014 patients who underwent tympanoplasty for chronic otitis media from 2006 to 2011, those aged over 70 years were eligible for inclusion. MAIN OUTCOME MEASURES Clinical characteristics including tympanosclerosis and preoperative severe complications were investigated. In chronic otitis media group, hearing outcomes (air-bone gap at 500-Hz and 1- and 2-kHz frequency) and postoperative ear condition were investigated. In chronic otitis media with cholesteatoma, clinical characteristics including postoperative bone conduction hearing threshold (at 500-Hz and 1- and 2-kHz frequency) were investigated. RESULTS Ninety-seven ears of 83 patients were included. Eighteen ears had obvious findings of tympanosclerosis (18/97 = 18.6%). In chronic otitis media without cholesteatoma (52 ears/47 patients), no preoperative complications were noted. The mean air-bone was 30.8 and 16.1 dB before and after the operation, respectively (p < 0.001). Otorrhea disappeared in 51 ears (98.1%). In chronic otitis media with cholesteatoma (42 ears/33 patients), we noted preoperative severe complications including labyrinthine fistula (7/97 = 7.22%), widely exposed dura (1/97 = 1.03%), and facial palsy 1 (1/97 =1.03%). The mean bone conduction hearing threshold was 39.6 dB and 40.89 dB, respectively (p = 0.7). Three ears of 3 patients had operated ears with open mastoid and underwent canal wall reconstruction tympanoplasty. CONCLUSION Tympanoplasty in elderly patients older than 70 years seems to be as safe as when performed in younger patients.
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