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Xun M, Liu X, Sha Y, Zhang X, Liu JP. The diagnostic utility of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography for cholesteatoma: A meta-analysis. Laryngoscope Investig Otolaryngol 2023; 8:627-635. [PMID: 37342121 PMCID: PMC10278117 DOI: 10.1002/lio2.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The purpose of this meta-analysis was to compare the efficiency of high-resolution computed tomography (HRCT) and diffusion-weighted magnetic resonance imaging (DWI) in guiding the diagnosis of middle ear cholesteatoma in clinical practice. Materials and methods Cochrane Library, Medline, Embase, PubMed, and Web of Science were searched for studies that evaluated the sensitivity and specificity of HRCT or DWI in detecting middle ear cholesteatoma. A random-effects model was used to calculate and summarize the pooled estimates of sensitivity, specificity, and diagnostic odds ratios. Postoperative pathological results were considered as the diagnostic gold standard for middle ear cholesteatoma. Results Fourteen published articles (860 patients) met the inclusion criteria. The sensitivity and specificity of DWI when diagnosing cholesteatoma (regardless of type) were 0.88 (95% confidence interval [CI], 0.80-0.93) and 0.93 (95% CI, 0.86-0.97), respectively, while those of HRCT were 0.68 (95% CI, 0.57-0.77) and 0.78 (95% CI, 0.60-0.90), respectively. Notably, the sensitivity and specificity levels of DWI were similar to those of HRCT (p = .1178 for sensitivity, p = .2144 for specificity; pair-sampled t tests). The sensitivity and specificity of DWI or HRCT for the diagnosis of primary cholesteatoma were 0.78 (95% CI, 0.65-0.88) and 0.84 (95% CI, 0.69-0.93), respectively, while that for recurrent cholesteatoma were 0.93 (95% CI, 0.61-0.99) and 0.94 (95% CI, 0.82-0.98), respectively. Conclusion DWI and HRCT have similar levels of high sensitivity and specificity in detecting various cholesteatomas. Also, the diagnostic efficiency of HRCT or DWI for recurrent cholesteatoma is identical to that of primary cholesteatoma. Therefore, HRCT may be used in clinical settings to reduce the use of DWI and save clinical resources. Lay summary Data on the use of diffusion-weighted magnetic resonance imaging and high-resolution computed tomography in the diagnosis of cholesteatoma were obtained through a literature search. They were analyzed to guide the clinical diagnosis and treatment of cholesteatoma. Level of evidence NA.
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Affiliation(s)
- Mengzhao Xun
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xu Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Yongfang Sha
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Xin Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
| | - Jian Ping Liu
- ENT Institute and Department of Otorhinolaryngology, Eye and ENT HospitalFudan UniversityShanghaiChina
- NHC Key Laboratory of Hearing Medicine (Fudan University)ShanghaiChina
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Localization Evaluation of Primary Middle Ear Cholesteatoma With Fusion of Turbo Spin-Echo Diffusion-Weighted Imaging and High-Resolution Computed Tomography. J Comput Assist Tomogr 2023; 47:144-150. [PMID: 36395525 DOI: 10.1097/rct.0000000000001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate the application of high-resolution computed tomography (HRCT) and turbo spin-echo diffusion-weighted imaging (TSE-DWI) fusion imaging for localization of middle ear cholesteatomas. METHODS Eighty-six patients with clinically suspected middle ear cholesteatomas were enrolled prospectively. Ear TSE-DWI and HRCT scans were performed using a postprocessing workstation to generate a TSE-DWI-CT fusion image. Subsequently, all the enrolled patients received surgical treatment. According to the STAM system (difficult access sites [S], the tympanic cavity [T], the attic [A], and the mastoid [M]), the agreement between the localization of lesions evaluated by HRCT, TSE-DWI, and TSE-DWI-CT fusion images and the intraoperatively recorded localization were computed using Cohen κ statistic. RESULTS Based on the pathological results, the enrolled patients were divided into a cholesteatoma (n = 50) and a noncholesteatoma group (n = 36). The area under the receiver operator characteristic curve for diagnosis of cholesteatoma with TSE-DWI-CT fusion imaging was identical to that using the TSE-DWI images (0.924 vs 0.924, P > 0.05), but was significantly higher than that with HRCT imaging (0.924 vs 0.767, P = 0.0005). Furthermore, the diagnostic sensitivity and specificity of TSE-DWI-CT fusion imaging for cholesteatomas were 96.0% and 88.9%, respectively. Depending on whether the cholesteatoma extended to the mastoid, TSE-DWI-CT fusion imaging demonstrated good agreement with the intraoperative record for localization of lesions (κ = 0.808) and had a high accuracy of localization by the STAM system. CONCLUSIONS Turbo spin-echo-DWI-CT fusion images have a very high diagnostic value for the preoperative localization of cholesteatomas.
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Revanth S, Nagadi AN, Murthy S, Sachidananda R, Raghu V, Chadaga H, Haldipur D. Utility of Non-EPI DWI MRI Imaging in Cholesteatoma: The Indian Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:3919-3926. [PMID: 36742588 PMCID: PMC9895567 DOI: 10.1007/s12070-021-02704-8] [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: 03/28/2021] [Accepted: 06/20/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this prospective observational study was to evaluate the diagnostic performance of non-EPI-based techniques, in detecting both primary and residual/recurrent cholesteatoma in a tertiary care center. 56 patients (25 female and 31 male) aged between 6 and 59 years were prospectively evaluated for the presence or absence of cholesteatoma. This included both primary and postoperative recurrent cholesteatoma (16). All the patients underwent sequential CT scans of temporal bones and non-EPI DWI (Non-Echo Planar Diffusion-Weighted Imaging) MRI techniques. The findings were correlated with surgical findings regarding the presence or absence of cholesteatoma. The size of cholesteatoma that was diagnosed on non-EPI DWI MRI was measured. The smallest size was 6 mm and the largest one was 21 mm. The accuracy of non-EPI DWI MRI in diagnosing cholesteatoma (primary and recurrent) was 97.5%. Whereas in diagnosing recurrent cholesteatoma accuracy was 100%. Accuracy of non-EPI DWI MRI is very high in diagnosing cholesteatoma especially in recurrent cholesteatoma and can potentially replace second look surgery when intact canal wall techniques are used. The technique is best used with a CT Scan of the temporal bone to depict bony changes, anatomical variants, or complications. The combination of HRCT and non-EPI DWI needs to be employed in diagnosing primary and recurrent cholesteatoma to maximize the diagnostic benefit as they are complimentary.
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Affiliation(s)
- S. Revanth
- Department of Radiology, Columbia Asia Hospitals, Bengaluru, India
| | - Anita N. Nagadi
- Department of Radiology, Columbia Asia Hospitals, Bengaluru, India
| | - Sreenivasa Murthy
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
| | - Ravi Sachidananda
- Department of ENT/Head and Neck Surgery, People Tree Hospitals, Bengaluru, India
| | - Vineetha Raghu
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
| | - Harsha Chadaga
- Department of Otolaryngology, Columbia Asia Hospitals, Bengaluru, India
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Bu DD, Schwam ZG, Kaul VF, Wong K, Fan C, Wanna GB, Cosetti MK, Perez E. Cost-effectiveness of Canal Wall-Up vs Canal Wall-Down Mastoidectomy: A Modeling Study. Otolaryngol Head Neck Surg 2022; 167:552-559. [PMID: 35133895 DOI: 10.1177/01945998221076051] [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: 11/15/2022]
Abstract
OBJECTIVE To assess the relative lifetime costs, benefits, and cost-effectiveness between the 2 approaches, canal wall-up (CWU) and canal wall-down (CWD) tympanomastoidectomy, used in the treatment of cholesteatomas. STUDY DESIGN Markov state transition model. SETTING Tertiary academic health system. METHODS A Markov state transition model was used to simulate outcomes across the patient lifetime. Outcome and complication probabilities were obtained from the existing literature. Costs were calculated from the payer perspective, with procedure, hospital, clinic, and physician cost derived from Medicare reimbursement. Quality-adjusted life years (QALYs) were used to represent effectiveness and utility. One-way and probability sensitivity analyses (PSAs) were conducted. RESULTS The base case analysis, assuming a 40-year-old patient, yielded a lifetime cost of $14,214 for a patient treated with the CWU approach assuming second-look surgery and $22,290 with a CWD approach. CWU and CWD generated a benefit of 17.11 and 17.30 QALYs, respectively. The incremental cost-effectiveness ratio for CWU was $43,237 per QALY. The Monte Carlo PSA validated the base case scenario. Using a standard $50,000 willingness-to-pay threshold, CWD was the more cost-effective approach and was selected 54.8% of the time by the simulation. CONCLUSION Both CWU and CWD were found to be cost-effective, with CWD being cost-effective 54.8% of the time at a WTP threshold of $50,000. The assumptions used in the analysis were validated by the results of 1-way and PSA.
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Affiliation(s)
- Daniel D Bu
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Zachary G Schwam
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Vivian F Kaul
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Caleb Fan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - George B Wanna
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Maura K Cosetti
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Enrique Perez
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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New Compartmental Reading Method for MRI Enables Accurate Localization of Cholesteatomas With High Sensitivity and Specificity. Otol Neurotol 2021; 42:431-437. [PMID: 33555752 DOI: 10.1097/mao.0000000000002999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cholesteatoma is an inflammatory disease, frequently observed in childrens and young adults, with a risk of relapse or recurrence. The few studies which analyzed cholesteatoma localization on magnetic resonance imaging (MRI) usually merged CT-MR images or relied on their authors' anatomical knowledge. We propose a compartmental reading method of the compartments of the middle ear cavity for an accurate localization of cholesteatomas on MR images alone. MATERIAL AND METHODS Our method uses easily recognizable anatomical landmarks, seen on both computed tomography (CT) and MRI, to delimit the middle ear compartments (epitympanum, mesotympanum, hypotympanum, retrotympanum, protympanum, antrum-mastoid cavity). We first tested it on 50 patients on non-enhanced temporal bone CT. Then, we evaluated its performances for the localization of cholesteatomas on MRI, compared with surgery on 31 patients (validation cohort). RESULTS The selected anatomical landmarks that delimited the middle ear compartments were applicable in 98 to 100% of the cases. In the validation cohort, we were able to accurately localize the cholesteatoma on MRI in 83% of the cases (n = 26) with high sensitivity (95.7%) and specificity (98.6%). CONCLUSION With our compartmental reading method, based on the recognition of well-known anatomical landmarks to differentiate the compartments of the middle ear cavity on MRI, we were able to accurately localize the cholesteatoma with high (>90%) sensitivity and specificity. Such landmarks are widely applicable and only require limited learning time based on key images. Accurate localization of the cholesteatoma is useful for the choice of surgical approach.
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Correlation of pre-operative computed tomography, intra-operative findings and surgical outcomes in revision tympanomastoidectomy. The Journal of Laryngology & Otology 2021; 134:1096-1102. [PMID: 33407963 DOI: 10.1017/s0022215120002698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. METHODS This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. RESULTS Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). CONCLUSION Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.
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Singh P, Singh R, Rai R, Sethi S, Ahluwalia AS, Choudhary G. High-resolution computed tomography (HRCT) in pediatric and adult patients with unsafe chronic suppurative otitis media (CSOM) and its surgical correlation. J Family Med Prim Care 2020; 9:4067-4073. [PMID: 33110811 PMCID: PMC7586635 DOI: 10.4103/jfmpc.jfmpc_455_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 06/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aim: Atticoantral, alias unsafe type of CSOM affects the posterosuperior part of the middle ear cleft and is frequently coupled with complications and bony erosions. This study aimed to correlate the high-resolution computed tomography (HRCT) temporal bone and intraoperative findings in the patients with the unsafe type of CSOM. Methods: This prospective study included 50 patients (28 males: 22 females; mean age 24 ± 14 years) who presented with clinically suspected unsafe CSOM. All patients underwent HRCT of the temporal bone and subsequent surgical procedure. The intraoperative and histopathological findings were compared with HRCT findings. Descriptive statistics, sensitivity, specificity, and positive and negative predictive value for HRCT were calculated. Student's t-test and Chi-square test were performed. Results: Out of 50 patients, left, right, and bilateral ear involvement were seen in 42% (21/50), 38% (19/50), and 20% (10/50) patients, respectively. Ear discharge was the most common symptom (100%) followed by earache (66%), vertigo (16%), and tinnitus (14%), respectively. Cholesteatoma was reported in 82% (49/60) of ears on HRCT while histopathological and intraoperative evaluation confirmed the diagnosis in 40 out of 49 ears. In 18% (11/60) ears, the cholesteatoma was not diagnosed on HRCT evaluation; however, the intraoperative and histopathological assessment revealed cholesteatoma in six patients while the rest had granulation tissue. For detection of ossicular erosions, tegmen erosions, erosions of facial nerve canal, erosions of sigmoid sinus plate, and erosions of lateral/posterior semicircular canals; HRCT had high sensitivity (86.44%–100%) and specificity (93.33%–100%). Conclusion: HRCT has a superb correlation with intraoperative findings and is a valuable tool for preoperative assessment of temporal bone pathologies.
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Fan X, Liu Z, Ding C, Chang Z, Ma Q. The value of turbo spin-echo diffusion-weighted imaging apparent diffusion coefficient in the diagnosis of temporal bone cholesteatoma. Clin Radiol 2019; 74:977.e1-977.e7. [DOI: 10.1016/j.crad.2019.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/21/2019] [Indexed: 01/04/2023]
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9
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Li Q, Jia Y, Feng Q, Tang B, Luo X, Xu P, Wang D, Zhang X. Analysis on outcomes of facial paralysis complicated by middle ear cholesteatoma. Acta Otolaryngol 2019; 139:211-213. [PMID: 30762460 DOI: 10.1080/00016489.2018.1543951] [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: 10/27/2022]
Abstract
BACKGROUND The prognostic factors of facial paralysis complicated by middle ear cholesteatoma (MEC) are largely unknown due to limited reports and smaller sample size. OBJECTIVES This study aimed to analyze prognostic factors of postoperative outcomes of facial paralysis complicated by MEC. MATERIAL AND METHODS Clinical data of 48 patients (48 ears) with facial paralysis complicated by MEC were retrospectively reviewed and analyzed. The outcomes of facial paralysis were compared between different groups. RESULTS All the eight cases (100%) with intact fallopian canal had complete recovery of facial paralysis after surgery, while only 52.5% cases (21/40 cases) with fallopian canal damage achieved good recovery, with significant difference (p < .05). For subgroup analysis of the 40 cases with damaged fallopian canal, the good recovery rate of facial paralysis in shorter duration group (≤2 months) was higher compared to longer duration group (>2 months) (81.0% versus 21.1%; p < .05). Moreover, the good recovery rate of facial paralysis in moderate facial paralysis group (grade II-IV) was higher compared to severe facial paralysis group (grade V-VI) (82.4% versus 30.4%; p < .05). CONCLUSIONS AND SIGNIFICANCE The outcomes of facial paralysis complicated by MEC were associated with fallopian canal integrity, duration and severity of facial paralysis.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yanfei Jia
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Qian Feng
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Bo Tang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaodong Luo
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Xu
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Daowen Wang
- Department of Otolaryngology Head and Neck Surgery, Peking University, Beijing, China
| | - Xuanfen Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
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Garcia-Iza L, Guisasola A, Ugarte A, Navarro JJ, Goiburu M, Altuna X. Utility of diffusion-weighted magnetic resonance imaging in the diagnosis of cholesteatoma and the influence of the learning curve. Eur Arch Otorhinolaryngol 2018; 275:2227-2235. [DOI: 10.1007/s00405-018-5074-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023]
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11
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Wang JJ, Feng YM, Wang H, Wu YQ, Shi HB, Chen ZN, Yin SK. Postoperative efficacy analysis of patients with facial nerve palsy associated with cholesteatoma otitis media: Our experience with 32 patients. Clin Otolaryngol 2017; 43:732-735. [PMID: 29168315 DOI: 10.1111/coa.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- J-J Wang
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Y-M Feng
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - H Wang
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Y-Q Wu
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - H-B Shi
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Z-N Chen
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - S-K Yin
- Otolaryngology Institute, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Effect of surgical intervention on middle-ear cholesteatoma with associated facial paralysis. The Journal of Laryngology & Otology 2016; 131:113-116. [PMID: 27989248 DOI: 10.1017/s0022215116009804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the presenting symptoms, intra-operative findings and long-term facial nerve function in patients treated for cholesteatoma with associated facial paralysis. METHODS Fifteen patients with facial paralysis due to middle-ear cholesteatoma who underwent tympanomastoidectomy surgery from February 2000 to February 2015 were retrospectively reviewed. After removal of the cholesteatoma, a limited area of the fallopian canal, in which facial nerve oedema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. RESULTS Pre-operative House-Brackmann grade was grade II in two patients, grade III in four, grade IV in seven, grade V in one and grade VI in one. Facial nerve perineurium damage was observed in two patients with poor prognoses. All patients treated within the first 15 days after paralysis onset showed normal facial function at long-term follow up. Post-operative House-Brackmann grade was grade I in 11 patients, grade II in 1, grade III in 2 and grade VI in 1. CONCLUSION Early surgical treatment is more likely to give good results, and poor outcomes are observed in patients with facial nerve perineurium damage.
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Crowson MG, Ramprasad VH, Chapurin N, Cunningham CD, Kaylie DM. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope 2016; 126:2574-2579. [PMID: 26928951 DOI: 10.1002/lary.25941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies. STUDY DESIGN Retrospective review and cost analysis. METHODS Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits. RESULTS One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001). CONCLUSION The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2574-2579, 2016.
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Affiliation(s)
- Matthew G Crowson
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
| | - Vaibhav H Ramprasad
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Nikita Chapurin
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Calhoun D Cunningham
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - David M Kaylie
- Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
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