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Mulazimoglu S, Meco C. Endoscopic diving technique for hearing preservation in managing labyrinth-invading cholesteatomas. Eur Arch Otorhinolaryngol 2023; 280:1639-1646. [PMID: 36071251 DOI: 10.1007/s00405-022-07635-w] [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: 05/19/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Complete removal of the matrix over the existing fistula in the event of an extensive cholesteatoma with labyrinth invasion can result in total deafness. This study aimed to present a novel method of underwater endoscopic labyrinth dissection using continuous steroid irrigation (CSI) and systemic steroid administration for hearing preservation. METHODS The endoscopic diving technique (EDT) was used to dissect semicircular canals, revealing the underwater anatomy of membranous labyrinth structures, in two cadaver temporal bones. EDT with CSI was used in three clinical cases with extensive cholesteatoma. RESULTS On cadaver temporal bones, the anatomy of the lateral (LSC), superior (SSC), and posterior membranous semicircular canals with their respective ampullas and common crus was documented. In the first case managed with transcanal EDT, the LSC was eroded across almost its entire length. The fallopian canal was circumferentially eroded at the second genu and part of the mastoid segment. The cholesteatoma matrix was completely removed, and the membranous LSC was preserved. In the second and third cases, we were able to remove the cholesteatoma matrix along the eroded bony semicircular canals while keeping the membranes intact. No sensorineural hearing loss was detected in the postoperative masked pure-tone audiometry at a mean follow-up time of 12 months or cholesteatoma recurrence at the follow-up imaging. CONCLUSIONS EDT with CSI can be safely utilized in the course of temporal bone labyrinth dissections and provides advantages during cholesteatoma removal over the eroded labyrinth on preservation of the membranous structures, and thus may help preserve cochlear function.
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Affiliation(s)
- Selcuk Mulazimoglu
- Department of Otorhinolaryngology, Ankara University Medical School, Ankara, Turkey. .,Department of Anatomy, Ankara University Medical School, Ankara, Turkey.
| | - Cem Meco
- Department of Otorhinolaryngology, Ankara University Medical School, Ankara, Turkey.,Department of Anatomy, Ankara University Medical School, Ankara, Turkey.,Department of Otorhinolaryngology, Paracelsus Medical University, Salzburg, Austria
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Tomasoni M, Arcuri M, Dohin I, Zorzi S, Borsetto D, Piazza C, Redaelli de Zinis LO, Sorrentino T, Deganello A. Presentation, Management, and Hearing Outcomes of Labyrinthine Fistula Secondary to Cholesteatoma: A Systematic Review and Meta-analysis. Otol Neurotol 2022; 43:e1058-e1068. [PMID: 36190841 DOI: 10.1097/mao.0000000000003716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The current study systematically reviewed the literature to compare auditory outcomes of patients treated for labyrinthine fistula (LF) based on characteristics of disease and surgical management. DATABASES REVIEWED PubMed, Scopus, Web of Science. METHODS Original series (at least five cases) published from 2000 reporting management and hearing results of LF secondary to cholesteatoma were included. Proportion and odds-ratio (OR) meta-analyses were conducted through inverse variance random-effects models based on logit transformation. RESULTS The prevalence of LF is estimated to be 7% (95% confidence interval [CI], 5-9%). Fistulae involving the lateral semicircular canal (90%; 95% CI, 87-93%) and larger than 2 mm (53%; 95% CI, 43-64%) were common, whereas membranous involvement was less frequent (20%; 95% CI, 12-30%). Complete removal of the cholesteatoma matrix overlying the LF was mostly applied. Bone conduction (BC) preservation was frequently achieved (81%; 95% CI, 76-85%); new-onset postoperative anacusis was rarely reported (5%; 95% CI, 4-8%). A higher chance of BC preservation was associated with sparing the perilymphatic space (OR, 4.67; 95% CI, 1.26-17.37) or membranous labyrinth (OR, 4.56; 95% CI, 2.33-8.93), exclusive lateral semicircular canal involvement (OR, 3.52; 95% CI, 1.32-9.38), smaller size (<2 mm; OR, 3.03; 95% CI, 1.24-7.40), and intravenous steroid infusion (OR, 7.87; 95% CI, 2.34-26.42). CONCLUSION LF occurs in a significant proportion of patients with cholesteatoma. In the past two decades, complete removal of the cholesteatoma matrix followed by immediate sealing has been favored, supported by the high proportion of BC preservation. Hearing preservation depends primarily on characteristics of the LF, and specific surgical strategies should be pursued. Intraoperative and postoperative intravenous steroid infusion is recommended.
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Affiliation(s)
- Michele Tomasoni
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Mara Arcuri
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Isabelle Dohin
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Silvia Zorzi
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Daniele Borsetto
- Department of ENT Surgery, Cambridge University Hospitals, Cambridge, UK
| | - Cesare Piazza
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | | | - Tommaso Sorrentino
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Department of Otolaryngology-Head and Neck Surgery, ASST Spedali Civili, University of Brescia, Brescia, Italy
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Westerhout SF, Straatman LV, Dankbaar JW, Thomeer HG. Labyrinthine fistulas: Surgical outcomes and an additional diagnostic strategy. Am J Otolaryngol 2022; 43:103441. [PMID: 35397381 DOI: 10.1016/j.amjoto.2022.103441] [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: 02/28/2022] [Accepted: 04/03/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate perioperative findings and audiological and vestibular outcomes in patients operated for cholesteatoma with labyrinthine fistulas. Also to assess radiological fistula size. MATERIALS AND METHODS Patients who underwent surgery for a labyrinthine fistula caused by a cholesteatoma between 2015 and 2020 in a tertiary referral center were retrospectively investigated. Fistula size was determined on preoperative CT scan. Bone and air conduction pure tone average thresholds were obtained pre- and postoperatively. Clinical outcomes, such as vertigo and otorrea were also evaluated. Main purpose was to determine whether there is a correlation between fistula size and postoperative hearing. Furthermore, perioperative findings and vestibular outcomes are evaluated. RESULTS 21 patients (22 cases) with a labyrinthine fistula were included. There was no significant change after surgery in bone conduction pure tone average (preoperatively 27.6 dB ± 26.7; postoperatively 30.3 dB ± 34.3; p = 0.628) or air conduction pure tone average (preoperatively 58.7 dB ± 24.3; postoperatively 60.2 dB ± 28.3; p = 0.816). Fistula size was not correlated to postoperative hearing outcome. There were two patients with membranous labyrinth invasion: one patient was deaf preoperatively, the other acquired total sensorineural hearing loss after surgery. CONCLUSIONS Sensorineural hearing loss after cholesteatoma surgery with labyrinthine fistula is rare. Fistula size and postoperative hearing loss are not correlated, however, membranous labyrinthine invasion seems to be related to poor postoperative hearing outcomes. Therefore, additional preoperative radiological work up, by MRI scan, in selected cases is advocated to guide the surgeon to optimize preoperative counselling.
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Sun H, Wang T, Shi L, Zhuang S, Liu J. Clinical efficacy of the 'sandwich technique' in repairing cholesteatoma with labyrinthine fistula. Acta Otolaryngol 2022; 142:30-35. [PMID: 35001839 DOI: 10.1080/00016489.2021.2022207] [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 Labyrinthine fistula is the most common complication of middle ear cholesteatoma. AIMS/OBJECTIVES To explore the postoperative hearing changes and surgical results of repairing middle ear cholesteatoma with labyrinthine fistula using the 'sandwich technique'. MATERIALS AND METHODS We retrospectively studied the clinical data of 36 patients (36 ears) who underwent surgical treatment for cholesteatoma with labyrinthine fistula. All patients were treated by completely removing the cholesteatoma matrix and repairing the fistula using the 'sandwich technique'. The hearing, clinical features, radiological data, intraoperative findings, and surgical results were respectively analyzed. RESULTS Most labyrinthine fistulas were located in the lateral semicircular canal (94%). Fifty percent of fistulas were of medium size. Based on Dornhoffer classification, 17 cases of labyrinthine fistulas were classified as I. In 34 patients, the average bone conduction threshold improved or did not change after surgery. Two patients had preoperative facial paralysis. During follow-up (3-60 months), all patients had no postoperative vertigo symptoms and disease recurrence. CONCLUSIONS Following the removal of the cholesteatoma matrix, the fistula is repaired using the "sandwich technique", which preserves or increases hearing and achieves an anti-vertiginous effect. SIGNIFICANCE This finding suggests that, 'sandwich technique' is a feasible procedure to treat cholesteatoma with labyrinthine fistula.
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Affiliation(s)
- Huanhuan Sun
- Department of Otolaryngology, Changji Region Hospital of Traditional Chinese Medicine, Xinjiang, China
| | - Taiqin Wang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian, China
| | - Liangwen Shi
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian, China
| | - Suling Zhuang
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian, China
| | - Jianzhi Liu
- Department of Otolaryngology, Fujian Medical University Union Hospital, Fujian, China
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Kryukov AI, Garov EV, Moseikina LA, Kurilenkov GV, Chugunova MA, Pryakhina MA, Saydulaev VA. [A case of hearing preservation during surgical treatment of distributed fistula labyrinth in a patient with chronic purulent means otitis and cholesteatoma]. Vestn Otorinolaringol 2022; 87:99-106. [PMID: 35818953 DOI: 10.17116/otorino20228703199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article provides a brief overview of the epidemiology, diagnosis, clinical manifestations and surgical methods of treatment of labyrinthine fistulas (LF) in patients with chronic suppurative otitis media (CSOM) with cholesteatoma. The efficacy of various LF treatment techniques, their complications, and the principles of prevention of cochleovestibular disorders during surgical treatment are described. The prognostic criteria for the deterioration of bone conduction thresholds during LF surgery, which include a large LF size, the opening of the membranous labyrinth, and the extent of damage to the structures of the inner ear, are presented. A clinical case of surgical treatment of widespread LF in CSOM with cholesteatoma is presented, which proves the possibility of preserving the auditory and vestibular functions while observing the stages of sanitation, manipulations on the LF and obliteration of semicircular canals defects with auto tissues. Combined surgery of such a plan must certainly be accompanied by local instillation of solutions of hormonal preparations in case of a deficiency of perilymphatic fluid in the labyrinth and postoperative antibacterial and hormonal therapy.
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Affiliation(s)
- A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L A Moseikina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - G V Kurilenkov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M A Pryakhina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V A Saydulaev
- National medical reserch center of Otorhinolaryngology Moscow, Moscow, Russia
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Bartochowska A, Pietraszek M, Wierzbicka M, Gawęcki W. "Sandwich technique" enables preservation of hearing and antivertiginous effect in cholesteatomatous labyrinthine fistula. Eur Arch Otorhinolaryngol 2021; 279:2329-2337. [PMID: 34143282 PMCID: PMC8986723 DOI: 10.1007/s00405-021-06934-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Purpose The aim of the study was to assess hearing, surgical and clinical results of the treatment in patients with cholesteatomatous labyrinthine fistula (LF) focusing on the different techniques and materials used in the management. Methods Study group included 465 patients. Cases with LFs discovered or confirmed during surgical procedure were thoroughly analyzed. Results LFs were noted in 11.4% of all cases. Thirty-eight patients, with all follow-up data available, were included into the further analysis. Most LFs were located in the lateral semicircular canal (87%). LFs were assessed as small in 2 cases, as medium in 24 patients while 12 were described as large. Based on Dornhoffer and Milewski classification, 50% of LFs were classified as IIa, 24% as IIb, 6 LFs were very deep (type III), while 4—superficial (type I). The size and type of LF did not influence postsurgical complaints (p = 0.1070, p = 0.3187, respectively). Vertigo was less frequent in LFs treated by “sandwich technique”, especially those with opened endosteum. In 30 (79%) patients, hearing improved or did not change after surgery. Hearing outcomes were significantly better in the ears operated by means of CWU technique (p = 0.0339), in LFs with intact membranous labyrinth (p = 0.0139) and when “sandwich technique” was performed (p = 0.0159). Postsurgical bone conduction thresholds levels were significantly better in LFs covered by “sandwich method” (p = 0.0440). Conclusion “Sandwich technique” (temporal fascia–bone pate–temporal fascia) enables preservation of hearing as well as antivertiginous effect in patients with cholesteatomatous labyrinthine fistula.
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Affiliation(s)
- Anna Bartochowska
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland.
| | - Marta Pietraszek
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355, Poznan, Poland
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7
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Park KS, Shin BJ, Jang CH. Hypertrophic Pachymeningitis of the Internal Auditory Canal Induced by a Labyrinthine Fistula Complicated With Cholesteatoma. EAR, NOSE & THROAT JOURNAL 2020; 101:NP321-NP323. [PMID: 33215535 DOI: 10.1177/0145561320972612] [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: 11/15/2022] Open
Abstract
Hypertrophic pachymeningitis (HP) is defined by inflammation and thickening of the dura mater, and the etiologic factors are idiopathic or secondary to various conditions. To date, HP in the internal auditory canal (IAC) has rarely been reported. There have only been 3 reports of HP in the IAC. Magnetic resonance imaging showed enhancement of along the IAC and vestibule. After antibiotic treatment, enhancement was reduced with visible seventh and eighth nerves. The patient underwent tympanomastoidectomy. To our knowledge, this is the first case of HP associated with a labyrinth fistula complicated by cholesteatoma. We report MRI image with literatures.
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Affiliation(s)
- Kyeong Suk Park
- Department of Otolaryngology, 65417Chonnam National University Medical School, Gwangju, South Korea
| | - Bong-Jin Shin
- Department of Otolaryngology, 65417Chonnam National University Medical School, Gwangju, South Korea
| | - Chul Ho Jang
- Department of Otolaryngology, 65417Chonnam National University Medical School, Gwangju, South Korea
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8
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Sunwoo W, Lee SY, Seong J, Han YE, Park MH. Clinical Characteristics of Patients with Cochlear Fistulas Caused by Chronic Otitis Media with Cholesteatoma. J Int Adv Otol 2020; 16:40-46. [PMID: 32209518 PMCID: PMC7224444 DOI: 10.5152/iao.2020.7018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/19/2019] [Accepted: 12/31/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To analyze the clinical characteristics of cochlear fistulas (CFs) and propose a new fistula classification system with regard to the cochlea. MATERIALS AND METHODS A retrospective chart review was conducted between January 2008 and December 2015 to identify patients who had undergone surgery for cholesteatoma with an associated CF. The following data were collected: preoperative symptoms, findings of temporal bone computed tomography (TBCT), fistula stage, cholesteatoma classification, surgical technique, and pre- and postoperative pure-tone audiometry. RESULTS We analyzed a total of 159 patients, out of which 9 (5.7%) were diagnosed with a CF. The average duration of the chronic otitis media was 19.8 years. Cholesteatomas that induced CF rarely existed in the nonaggressive state; recurrent otorrhea was observed in all but one of our subjects. All the patients with CF had a distinct origin of cholesteatoma that developed from the retraction of posterior pars tensa; further, 88.9% cholesteatomas extended to and filled the sinus tympani. Preoperative audiometry revealed total hearing loss in 4 (44.4%) patients. Further, five patients with residual hearing before surgery had stage I fistulas, and the bone conduction thresholds remained stable after surgery. CONCLUSION Cochlear fistulas were often detected in patients with (1) a history of chronic otitis media (exceeding 10 years), (2) frequently recurring otorrhea, and (3) pars tensa cholesteatomas that extended to the posterior mesotympanum and filled the sinus tympani. Such patients can suffer from potentially severe and irreparable sensorineural hearing loss.
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Affiliation(s)
- Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Sang-Youp Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jeon Seong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Young Eun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Min-Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
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Kryukov AI, Kynelskaya NL, Garov EV, Zelikovich EI, Baybakova EV, Zelenkova VN, Garova EE, Martirosyan TG. [Variants of treatment of the head direction at the festulars of the labi-rint of inflammatory genesis]. Vestn Otorinolaringol 2019; 84:20-25. [PMID: 31793522 DOI: 10.17116/otorino20198405120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyze the effectiveness of various methods of treating dizziness with fistulas of the labyrinth (FL) of inflammatory genesis. An analysis of the surgical treatment of 216 patients with chronic suppurative otitis media (CSOM) with cholesteatoma complicated by FL using a variety of FL treatment methods is presented. All patients underwent a debridement operation on the middle ear or revision of the postoperative cavity: in 48 patients with a matrix of cholesteatoma in situ on the fistula, in 109 patients with matrix removal followed by plastic repair or FL filling with various autotissues, in 59 patients with matrix conservation, plastic removal or filling FL and SLD labyrinth. In the last two groups, filling of a semicircular canal (SC) defect was performed in 33 patients, and mastoidoplasty - in 47. CONCLUSION All used FL treatment techniques are effective in the treatment of peripheral vestibular disorders. Careful treatment of SC fistula after removal of all pathological conditions in the absence of active inflammation and the appointment of hormone therapy in the postoperative period are the main factors in preserving the functions of the labyrinth in any surgical technique. Filling of the lumen of the SC and mastoidoplasty in patients with CSOM with FL can eliminate peripheral dizziness.
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Affiliation(s)
- A I Kryukov
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - N L Kynelskaya
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E V Garov
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E I Zelikovich
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E V Baybakova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - V N Zelenkova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - E E Garova
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
| | - T G Martirosyan
- Sverzhevskiy's Otorhinolaryngology Healthcare Research Institute, Moscow, Russia, 117152
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Covelli E, Talamonti R, Benincasa AT, Filippi C, Marrone V, Tarentini S, Monini S, Barbara M. Video Head Impulse Test in Labyrinthine Fistula due to Middle Ear Cholesteatoma. J Int Adv Otol 2019; 15:283-288. [PMID: 31257189 DOI: 10.5152/iao.2019.5678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess and monitor lateral semicircular canal (LSC) function over time in patients affected by chronic otitis media with cholesteatoma (CHO) complicated by fistula of LSC (LSC-F) before and after surgery using video Head Impulse Test (vHIT). MATERIALS AND METHODS Eight patients aged 18-67 years affected by CHO with imaging-ascertained LSC-F were included in this preliminary prospective study. The following protocol has been applied: oto-microscopic diagnosis with patient's history; computed tomography scan of the temporal bone; surgery with concomitant resurfacing of LSF-F; audiological and vestibular evaluation before surgery (T0) and at 30 days (T1), 6 months (T2), and 1 year after surgery (T3). vHIT was used to assess vestibulo-ocular reflex (VOR) in LSC. RESULTS None of the patients showed deterioration of bone conduction hearing levels during the different time of evaluation. Three patients showed a reduced VOR gain and catch-up saccades at T0, with VOR gain normalization at T2. This finding remained stable at the 1-year follow-up. The VOR gain in the nonaffected side generally experienced an increase, paralleled by the normalization on the affected side, with statistically significant correlation. The subjects with normal vHIT before surgery did not show any variation following surgery. CONCLUSION vHIT allows the assessment of LSC function in case of fistula. The adopted surgical fistula repair did not induce deterioration of the auditory or LSC function, but indeed, it could prevent worsening and help promoting recovery to the normal function.
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Affiliation(s)
- Edoardo Covelli
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Rita Talamonti
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Anna Teresa Benincasa
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Chiara Filippi
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Vania Marrone
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Silvia Tarentini
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Simonetta Monini
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
| | - Maurizio Barbara
- Department of Department of Neuroscience, Mental Health and Sense Organs NESMOS, Sapienza University, Rome, Italy
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11
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Baylan MY, Yılmaz Ü, Akkuş Z, Topçu İ. Assessment of Bone Conduction Thresholds After Surgical Treatment in Patients with Labyrinthine Fistula. Turk Arch Otorhinolaryngol 2018; 56:89-94. [PMID: 30197806 DOI: 10.5152/tao.2018.3238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/21/2018] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to analyze the bone conduction thresholds before and after surgery in chronic otitis media patients with cholesteatoma who had labyrinthine fistula and whose cholesteatoma matrix had been completely cleaned. Methods The study was performed between 2013 to 2017 with 23 chronic otitis media patients who had labyrinthine fistula with cholesteatoma and who were operated at the Department of Otorhinolaryngology of Dicle University School of Medicine. Patients were assessed by anamnesis and examination and when necessary, by temporal computerized tomography and diffusion magnetic resonance imaging. Bone conduction thresholds at frequencies of 500, 1000, 2000, and 4000 Hz were determined by audiometric examination and they were compared before and after surgery. Results Of the 23 patients, 12 were female and 11 were male; their age range was 10-55 (26.04±14.13) years. In the post-operative period, it was possible to conduct audiological follow-up on 20 patients. In these follow-ups, 16 patients showed no change in bone conduction thresholds, two patients showed worsening, and two showed improvement. When pre- and post-operative bone conduction thresholds at each frequency were compared separately, no significant difference was found (p=0.937). No statistically significant difference was found between the pre- and post-operative means at the four frequencies (p=0.712). Conclusion In this study, we found that to reduce complications relating to cholesteatoma, it might be necessary to completely remove the matrix especially in the case of type 1 and 2 labyrinthine fistulas.
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Affiliation(s)
| | - Ümit Yılmaz
- Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Zeki Akkuş
- Department of Biostatistics, Dicle University School of Medicine, Diyarbakır, Turkey
| | - İsmail Topçu
- Department of Otorhinolaryngology, Dicle University School of Medicine, Diyarbakır, Turkey
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12
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Geerse S, de Wolf MJF, Ebbens FA, van Spronsen E. Management of labyrinthine fistula: hearing preservation versus prevention of residual disease. Eur Arch Otorhinolaryngol 2017; 274:3605-3612. [PMID: 28799140 PMCID: PMC5591808 DOI: 10.1007/s00405-017-4697-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/31/2017] [Indexed: 11/28/2022]
Abstract
The objective of the study was to evaluate postoperative hearing and disease control after cholesteatoma surgery for labyrinthine fistulas. In a retrospective cohort study, we evaluated a consecutive cohort comprising 44 patients (45 ears) with labyrinthine fistulas associated with chronic otitis media with cholesteatoma who underwent surgery between 2002 and 2015. We looked at patient characteristics, pre- and postoperative bone conduction thresholds (BCT), operative approach and findings, extent of disease and the occurrence of residual disease. All deaf ears (24%) presented preoperatively with a large fistula. Opening the membranous labyrinth resulted in significantly worse postoperative BCT (p = 0.01). Neither the present study nor a literature search revealed a significant positive effect of corticosteroids on postoperative hearing preservation. Large fistulas were correlated with poorer preoperative BCTs, but not with poorer postoperative BCTs. Opening the membranous labyrinth during surgery is correlated with poorer postoperative BCTs and can be seen as a predictive parameter. The use of corticosteroids in the perioperative management of labyrinthine fistula was not found to result in any improvement in postoperative BCTs.
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Affiliation(s)
- S Geerse
- Department of Otorhinolaryngology Head and Neck Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - M J F de Wolf
- Department of Otorhinolaryngology Head and Neck Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - F A Ebbens
- Department of Otorhinolaryngology Head and Neck Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - E van Spronsen
- Department of Otorhinolaryngology Head and Neck Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Abstract
OBJECTIVE There is uncertainty regarding the ideal surgical management of cholesteatomatous labyrinthine fistulae. The objective was to review the published evidence to determine whether a difference exists in hearing outcome for cholesteatoma matrix removal or matrix exteriorization. DATA SOURCES Systematic MEDLINE and Web of Science searches identified publications describing hearing results after cholesteatoma matrix removal or matrix exteriorization. REVIEW METHODS Three reviewers appraised the studies for quality, level of evidence, and extracted data. Fistula characteristics such as single-site, multisite, size, grade, and follow-up time were extracted for subanalyses, and when appropriate, data were pooled for statistical analysis. RESULTS Twenty-eight articles met inclusion criteria, and the level of evidence was judged no better than level 3b. There was no difference in hearing preservation detected between matrix removal and exteriorization (87% for matrix removal, 95% CI, 0.82-0.90; 95% for exteriorization, 95% CI, 0.85-0.98). An analysis of the individual cohort studies that compared these groups directly did not show a difference in calculated odds ratio (OR), 0.96 (95% CI, 0.66-1.40). CONCLUSION The level of evidence on which to base surgical decision making related to cholesteatomatous labyrinthine fistula is poor, and the data do not demonstrate significant differences in hearing outcomes based on surgical technique.
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Affiliation(s)
- John Lim
- 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA
| | - Anupriya Gangal
- 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA
| | - Michael Brian Gluth
- 1 University of Chicago, Section of Otolaryngology-Head & Neck Surgery & Pritzker School of Medicine, Chicago, Illinois, USA
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14
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Kim HC, Jang CH, Sung CM, Jung EK, Cho YB. Congenital malleus bar without congenital aural stenosis or atresia. Braz J Otorhinolaryngol 2016; 86:662-664. [PMID: 27649633 PMCID: PMC9422726 DOI: 10.1016/j.bjorl.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/21/2016] [Accepted: 08/04/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Hong Chan Kim
- Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea
| | - Chul Ho Jang
- Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea.
| | - Chung Man Sung
- Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea
| | - Eun Kyung Jung
- Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea
| | - Yong Beom Cho
- Chonnam National University Medical School, Department of Otolaryngology, Gwangju, South Korea
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15
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Jang CH, Kim YY, Seong JY, Kang SH, Jung EK, Sung CM, Kim SB, Cho YB. Clinical characteristics of pediatric external auditory canal cholesteatoma. Int J Pediatr Otorhinolaryngol 2016; 87:5-10. [PMID: 27368435 DOI: 10.1016/j.ijporl.2016.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND & OBJECTIVE External auditory canal cholesteatoma (EACC) is caused by an invasion of squamous tissue into a localized area of periosteitis in the bony canal wall. The clinical characteristics of pediatric EACC are still unknown because of its rare occurrence. To date, only a single paper has reported that pediatric EACC has a less aggressive growth pattern compared to adult EACC. Further studies are required to understand the clinical behavior of EACC, i.e., its aggressiveness. The purpose of this study was to evaluate the clinical characteristics of pediatric EACC. MATERIALS AND METHODS The clinical records of all patients diagnosed with EACC in our department from January 1, 2012 to February 29, 2016 were retrospectively reviewed, focusing on the extension of bone erosion, symptoms, and clinical findings. RESULTS Seven patients had primary pediatric EACC (age range, 5-17 years). All patients showed unilateral EACC. Otalgia and intermittent otorrhea were common symptoms. Bacterial cultures were performed for four patients with otorrhea, which was controlled by diluted vinegar irrigation with a topical antibiotic solution. The most common bone destruction sites were the inferior and posterior walls. All patients required surgical treatment. Four patients (patient nos. 1, 3, 4, and 5) were treated via a postauricular transcanal approach. Three patients (patient nos. 2, 6, and 7) required mastoidectomy. CONCLUSION Pediatric EACC is not less aggressive than adult EACC. Therefore, early diagnosis and adequate treatment are necessary. Further studies are required to elucidate the clinical features of pediatric spontaneous EACC.
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Affiliation(s)
- Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea.
| | - Young Yoon Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Yuap Seong
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Hoon Kang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Eun Kyung Jung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung Beom Kim
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
| | - Yong Beom Cho
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju, South Korea
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16
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Meyer A, Bouchetemblé P, Costentin B, Dehesdin D, Lerosey Y, Marie JP. Lateral semicircular canal fistula in cholesteatoma: diagnosis and management. Eur Arch Otorhinolaryngol 2015; 273:2055-63. [DOI: 10.1007/s00405-015-3775-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/31/2015] [Indexed: 12/01/2022]
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