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Xu Y, Bei Z, Li M, Ye L, Chu B, Zhao Y, Qian Z. Biomedical application of materials for external auditory canal: History, challenges, and clinical prospects. Bioact Mater 2024; 39:317-335. [PMID: 38827173 PMCID: PMC11139775 DOI: 10.1016/j.bioactmat.2024.05.035] [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: 12/13/2023] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024] Open
Abstract
Biomaterials play an integral role in treatment of external auditory canal (EAC) diseases. Regarding the special anatomic structure and physiological characteristics of EAC, careful selection of applicable biomaterials was essential step towards effective management of EAC conditions. The bioactive materials can provide reasonable biocompatibility, reduce risk of host pro-inflammatory response and immune rejection, and promote the healing process. In therapeutic procedure, biomaterials were employed for covering or packing the wound, protection of the damaged tissue, and maintaining of normal structures and functions of the EAC. Therefore, understanding and application of biomaterials was key to obtaining great rehabilitation in therapy of EAC diseases. In clinical practice, biomaterials were recognized as an important part in the treatment of different EAC diseases. The choice of biomaterials was distinct according to the requirements of various diseases. As a result, awareness of property regarding different biomaterials was fundamental for appropriate selection of therapeutic substances in different EAC diseases. In this review, we firstly introduced the characteristics of EAC structures and physiology, and EAC pathologies were summarized secondarily. From the viewpoint of biomaterials, the different materials applied to individual diseases were outlined in categories. Besides, the underlying future of therapeutic EAC biomaterials was discussed.
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Affiliation(s)
- Yang Xu
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongwu Bei
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mei Li
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Ye
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingyang Chu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wahdini SI, Idamatussilmi F, Pramanasari R, Prawoto AN, Wungu CDK, Putri IL, Gunadi. Genotype-phenotype associations in microtia: a systematic review. Orphanet J Rare Dis 2024; 19:152. [PMID: 38594752 PMCID: PMC11003020 DOI: 10.1186/s13023-024-03142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Microtia is a congenital ear malformation that can occur as isolated microtia or as part of a syndrome. The etiology is currently poorly understood, although there is strong evidence that genetics has a role in the occurrence of microtia. This systematic review aimed to determine the genes involved and the abnormalities in microtia patients' head and neck regions. METHODS We used seven search engines to search all known literature on the genetic and phenotypic variables associated with the development or outcome of microtia. The identified publications were screened and selected based on inclusion and exclusion criteria and assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tools. We found 40 papers in this systematic review with phenotypic data in microtia involving 1459 patients and 30 articles containing genetic data involved in microtia. RESULT The most common accompanying phenotype of all microtia patients was external ear canal atresia, while the most common head and neck abnormalities were the auricular, mental, and oral regions. The most common syndrome found was craniofacial microsomia syndrome. In the syndromic microtia group, the most common genes were TCOF1 (43.75%), SIX2 (4.69%), and HSPA9 (4.69%), while in the non-syndromic microtia group, the most frequently found gene was GSC exon 2 (25%), FANCB (16.67%), HOXA2 (8.33%), GSC exon 3 (8.33%), MARS1 (8.33%), and CDT1 (8.33%). CONCLUSIONS Our systematic review shows some genes involved in the microtia development, including TCOF1, SIX2, HSPA9, GSC exon 2, FANCB, HOXA2, GSC exon 3, MARS1, and CDT1 genes. We also reveal a genotype-phenotype association in microtia. In addition, further studies with more complete and comprehensive data are needed, including patients with complete data on syndromes, phenotypes, and genotypes.
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Affiliation(s)
- Siti Isya Wahdini
- Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Fina Idamatussilmi
- Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Rachmaniar Pramanasari
- Plastic Reconstructive and Aesthetic Surgery Department, Faculty of Medicine, Airlangga University/Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Almas Nur Prawoto
- Plastic Reconstructive and Aesthetic Surgery Department, Faculty of Medicine, Airlangga University/Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia
| | - Indri Lakhsmi Putri
- Plastic Reconstructive and Aesthetic Surgery Department, Faculty of Medicine, Airlangga University/Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Genetics Working Group/Translational Research Unit, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
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Gantner S, Epp A, Pollotzek M, Hempel JM. Long-term results and quality of life after vibrant soundbridge implantation (VSBs) in children and adults with aural atresia. Eur Arch Otorhinolaryngol 2024; 281:129-139. [PMID: 37603051 PMCID: PMC10764446 DOI: 10.1007/s00405-023-08100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effectiveness and acceptance of the active middle ear implant system Vibrant Soundbridge (VSB®, MED-EL, Austria) in patients with aural atresia or aplasia (children and adults). METHODS Data from 51 patients (mean age 13.9 ± 11.3 years), 42 (79.2%) children and adolescents, and 11 (20.8%) adults) who received a VSB implant between 2009 and 2019 at the Department of Otolaryngology at LMU Clinic Großhadern, Munich were included in the study. Pure-tone audiometry, speech recognition in a quiet environment and in a noisy environment were performed preoperatively, during the first fitting of the audio processor, after 1-3 years, after 3-5 years, and after 5 years (if possible). The follow-up period ranged from 11 to 157 months with a mean of 58.6 months (4.8 years). Furthermore, the benefit of the VSB was evaluated by self-assessment questionnaires (Speech, Spatial, and Qualities of Hearing Scale, respectively, for parents). RESULTS Significant improvements were observed in hearing and speech comprehension immediately after the initial fitting of the VSB system (mean hearing gain 38.4 ± 9.4 dB HL) and at follow-up intervals (1-3, 3-5 and after 5 years) for children and adults (p < 0.01). The values remained stable over the long-term, indicating a sustained functional gain from the VSB (mean hearing gain 38.9 ± 9.2 dB HL). The results of the self-assessments affirm the positive influence on hearing and speech comprehension with the VSB. With the VSB, there was an improvement of 41.3 ± 13.7% in the Freiburg monosyllable test. CONCLUSION These results (a stable hearing gain over the long term, a good tolerance of the implant and an improvement in quality of life) affirm the recommendation for using the active middle ear implant VSB as early as permitted for aural atresia and aplasia patients. This study represents the audiometric results with the (to date) largest collective of aural atresia patients and with a long follow-up period.
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Affiliation(s)
- Sophia Gantner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany.
| | - Alexandra Epp
- Paediatric Hospital, University Hospital, Augsburg, Germany
| | - Marlene Pollotzek
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - John Martin Hempel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
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Brandt HH, Bodmer D. [Contemporary diagnosis and management of congenital microtia and aural atresia : Part 2: Overview of therapeutic approaches]. HNO 2024; 72:57-68. [PMID: 38047932 PMCID: PMC10781867 DOI: 10.1007/s00106-023-01386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 12/05/2023]
Abstract
Congenital malformations of the pinna and aural atresia can result in major aesthetic and functional deficits. Knowledge about embryologic developments and established classification systems is an essential requirement when dealing with affected patients. Early detection of deficiencies and introduction of appropriate diagnostic measures is vital to initiate adequate therapies and prevent long-term disabilities. Treatment for malformations of the pinna-if requested-is mostly surgical, infrequently an epithesis is applied. As in other surgical fields, tissue engineering will likely play a crucial role in the future. Treatment of aural stenosis and atresia aims at improvement of hearing levels and prevention of secondary complications like cholesteatoma and chronic otorrhea. Auditory rehabilitation comprises a spectrum from conventional hearing aids to invasive hearing implants, the latter being favored in recent years.
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Affiliation(s)
- Hannes H Brandt
- Klinische Abteilung für Hals‑, Nasen‑, Ohrenkrankheiten, Universitätsklinikum St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Österreich.
- Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Krems, 3500, Dr. Karl-Dorrek-Straße 30, Österreich.
| | - Daniel Bodmer
- Hals-Nasen-Ohren-Klinik, Universitätsspital Basel, Basel, 4031, Petersgraben 4, Schweiz
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Gutierrez JA, Shannon CM, Nguyen SA, Meyer TA, Lambert PR. Comparison of Transcutaneous and Percutaneous Implantable Hearing Devices for the Management of Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2024; 45:1-10. [PMID: 38085758 DOI: 10.1097/mao.0000000000004061] [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: 12/18/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for percutaneous (pBCD) versus transcutaneous (tBCD) implantable bone-conduction devices for the treatment of hearing loss associated with congenital aural atresia (CAA).Databases Reviewed.PubMed, Scopus, CINAHL. METHODS A systematic review was performed searching for English language articles from inception to December 14, 2022. Studies reporting audiometric outcomes or complications for either pBCDs or tBCDs for the treatment of CAA were selected for inclusion. A meta-analysis of single means and meta-analysis of proportions with comparison (Δ) of weighted proportions was conducted. RESULTS A total of 56 articles with 756 patients were selected for inclusion. One hundred ninety patients were implanted with pBCDs, whereas the remaining 566 were implanted with tBCDs. Mean pure-tone audiometry improvement in the pBCD group (39.1 ± 1.1 dB) was significantly higher than in the tBCD group (34.6 ± 1.6 dB; Δ4.5 dB; 95% confidence interval, 4.2-4.7 dB; p < 0.0001). The average improvement in speech reception threshold was 38.6 ± 2.5 dB in the percutaneous group as compared with 32.7 ± 1.6 dB in the transcutaneous group (Δ5.9 dB [5.3-6.5 dB], p < 0.0001). Overall complication rates for patients implanted with pBCDs and tBCDs were 29.0% (15.7-44.4%) and 9.4% (6.5%-13.0%), respectively (Δ19.6% [12.0-27.7%], p < 0.0001). CONCLUSIONS Patients with CAA implanted with pBCDs had significantly better audiometric outcomes than those implanted with tBCDs. However, complication rates were significantly higher among the pBCD group.
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Affiliation(s)
- Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Shannon CM, Gutierrez JA, Nguyen SA, Meyer TA, Lambert PR. Comparison of Outcomes of Surgery Versus Implantable Device for the Treatment of Hearing Loss Associated With Congenital Aural Atresia: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:758-766. [PMID: 37464461 DOI: 10.1097/mao.0000000000003950] [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: 07/20/2023]
Abstract
OBJECTIVE To compare audiometric outcomes, complications, and revisions required for implantable bone-conduction devices (BCDs) versus atresia surgery for the treatment of hearing loss associated with congenital aural atresia. DATABASES REVIEWED PubMed, Scopus, CINAHL. METHODS Databases were searched for English articles from inception to July 1, 2022, for studies reporting audiometric outcomes or complications for either BCDs or atresia surgery for the treatment of congenital aural atresia. Main outcome measures included pure-tone audiometry, air-bone gap, speech reception threshold, associated complications, and rates of revision for each treatment option. RESULTS We identified 973 abstracts, of which 89 were selected for data extraction and analysis. A total of 2,611 patients were included, 1,901 in the atresia surgery group and 710 in the BCDs group. A meta-analysis of single means was conducted for age and audiometric outcomes, and a meta-analysis of proportions was conducted for complications and revisions. The average short-term improvement in pure-tone audiometry for the BCDs group was 34.4 ± 1.6 dB compared with 22.4 ± 1.5 dB for the atresia surgery group, representing a significant difference (12.0 dB; 95% confidence interval, 11.9-12.2; p < 0.0001). A smaller proportion of complications were reported in the devices group (16.9%) compared with the atresia surgery group (45.7%). In addition, a smaller proportion of cases in the devices group required some degree of revision (17.8%) compared with the atresia surgery group (23.0%). CONCLUSIONS This study demonstrates that implantable BCDs have significantly better audiometric outcomes as well as a lower rate of complications and revisions required compared with atresia surgery.
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Affiliation(s)
- Christian M Shannon
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Yang L, Chen P, Liu Y, Yang J, Zhao S. Clinical manifestations and treatment strategies for congenital aural atresia with temporomandibular joint retroposition: a retrospective study of 30 patients. J Otolaryngol Head Neck Surg 2023; 52:24. [PMID: 36882877 PMCID: PMC9993528 DOI: 10.1186/s40463-022-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/07/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Patients with congenital aural atresia (CAA) can present with concomitant temporomandibular joint (TMJ) retroposition, implying that even with a high Jahrsdoerfer score, canaloplasty and tympanoplasty cannot be performed. Therefore, this study aimed to summarize the clinical manifestations and share our diagnostic and treatment experience of this rare entity, which has not been described previously. METHODS Thirty patients (30 ears) with CAA and TMJ retroposition without maxillofacial dysplasia were included. Diagnosis was based on patient history, physical examination, pure-tone average test results, and temporal bone high-resolution computed tomography (HRCT) findings. Their Jahrsdoerfer scores and interventions were also recorded. RESULTS Twenty-four and six patients among the 30 patients (males, n = 15) had CAA and TMJ retroposition on the right and left sides, respectively. Seventeen ears had a normal auricle; most had an enlarged cavum conchae and a large tragus. Twelve ears had an accessory auricle, and two had a preauricular fistula. All external auditory canals had complete atresia, including four with a shallow concavity and four with a small orifice in the cavum conchae. Temporal bone HRCT revealed poor or undeveloped tympanic temporal bone in the diseased ears, atresia in the external auditory canals, and partial/complete occupation of the mandibular condyle with or without soft tissue. The average Jahrsdoerfer score was 8.17. Thirteen patients opted for different surgeries, three wore a bone-conduction hearing aid, and fourteen chose no intervention. CONCLUSIONS CAA with TMJ retroposition was often unilateral, typically on the right side. Most patients had normal auricles, with an enlarged cavum conchae and a large tragus ("mirror ear"). Even with a high Jahrsdoerfer score, traditional hearing reconstruction surgery could not be performed. Patients can undergo Vibrant Soundbridge or Bonebridge implantation or wear bone-conduction hearing aids to improve hearing levels, or refuse intervention because of mild hearing loss. The TMJ location can be used as a Jahrsdoerfer Grading System supplement for preoperative evaluation.
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Affiliation(s)
- Lin Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Yujie Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinsong Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Dongjiaominxinag No. 1, Dongcheng District, Beijing, 100730, China.
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Park SM, Kim HJ, Son SE, Cho YS. Taste Changes after Atresioplasty in Patients with Congenital Aural Atresia. Otol Neurotol 2023; 44:e166-e170. [PMID: 36634251 DOI: 10.1097/mao.0000000000003806] [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: 01/14/2023]
Abstract
OBJECTIVE We evaluated chorda tympani nerve (CTN) and postoperative taste dysfunction according to anomaly severity and intraoperative CTN status. STUDY DESIGN Prospective observational study. SETTING Tertiary referral center, Samsung medical center hospital. PATIENTS Thirty-one patients who underwent atresioplasty by a single surgeon in a tertiary referral center were enrolled. INTERVENTIONS Therapeutic surgery. MAIN OUTCOME MEASURES Preoperative Schuknecht type and Jahrsdoerfer score and intraoperative CTN status were recorded, and a postoperative questionnaire was administered to evaluate taste function. RESULTS A significant difference was found among intact, cut, and unidentified groups in terms of Schuknecht type ( p = 0.000) and Jahrsdoerfer score (9.28 ± 1.11, 8.80 ± 0.83, 8.10 ± 0.93, p = 0.028). CTN was observed in Schuknecht type B, and not in type C ( p = 0.000), and was more likely to be observed as Jahrsdoerfer score increased ( p = 0.012). Taste disturbance tended to last longer in adult patients than in children. A significant difference was observed in the incidence of taste change between cut and intact CTN groups ( p = 0.018). CONCLUSION CTN was not identified during surgery in patients with Schuknecht type C anomalies, and there was no change in taste after surgery. Meanwhile, CTN was observed in all patients with Schuknecht type B anomalies, and CTN injury occurred in 41.67%. Therefore, CTN presence can be predicted by severity of anomaly, and patients with type B anomalies should be informed of the risk of CTN injury before surgery.
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Affiliation(s)
- Sung-Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Patel KR, Benchetrit L, Ronner EA, Occhiogrosso J, Hadlock T, Shaye D, Quesnel AM, Cohen MS. Development of an interdisciplinary microtia-atresia care model: A single-center 20-year experience. Laryngoscope Investig Otolaryngol 2022; 7:2103-2111. [PMID: 36544952 PMCID: PMC9764815 DOI: 10.1002/lio2.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Microtia and aural atresia are congenital ear anomalies with a wide-ranging spectrum of phenotypes and varied functional and psychosocial consequences for patients. This study seeks to analyze the management of microtia-atresia patients at our center over a 20-year period and to propose recommendations for advancing microtia-atresia care at a national level. Methods We performed a retrospective analysis of data from patients presenting to the Massachusetts Eye and Ear (Boston, MA) for initial otolaryngology consultation for congenital microtia and/or aural atresia between 1999 and 2018. Results Over the 20-year study period, 229 patients presented to our microtia-atresia center at a median age of 7 years. The severity of microtia was most commonly classified as grade III (n = 87, 38%), 61% (n = 140) of patients had complete atresia, the median Jahrsdoerfer grading scale score was 6 (range 0-10), and 81 patients (35%) underwent surgery for microtia repair. For hearing rehabilitation, 30 patients (64%) underwent bone conduction device implantation and 17 patients (36%) underwent atresiaplasty. The implementation of an interdisciplinary, longitudinal care model resulted in an increase in patient (r = 0.819, p < .001) and surgical volume (microtia surgeries, r = 0.521, p = .019; otologic surgeries, r = 0.767, p < .001) at our center over time. Conclusion An interdisciplinary team approach to microtia-atresia patient care may result in increased patient volume, which could improve aesthetic and hearing outcomes over time by concentrating care and surgical expertise. Future work should aim to establish standardized clinical consensus recommendations to guide the creation of high-quality microtia-atresia care programs. Level of Evidence 4.
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Affiliation(s)
- Krupa R. Patel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - Liliya Benchetrit
- Department of Otolaryngology—Head and Neck SurgeryBoston University Medical CenterBostonMassachusettsUSA
| | | | - Jessica Occhiogrosso
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - Tessa Hadlock
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - David Shaye
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - Alicia M. Quesnel
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael S. Cohen
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMassachusettsUSA
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Audiometric Outcomes After Surgical Repair of Congenital Aural Atresia: Does Age Matter? Otol Neurotol 2022; 43:814-819. [PMID: 35878639 DOI: 10.1097/mao.0000000000003599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To determine if there is an age-based difference in audiometric outcomes for patients undergoing primary congenital aural atresia (CAA) repair. STUDY DESIGN Retrospective chart review. SETTING Single academic, high-volume, tertiary care hospital. PATIENTS Individuals undergoing primary CAA repair by a single surgeon between 2004 and 2020. INTERVENTIONS CAA repair. MAIN OUTCOME MEASURES Preoperative and postoperative four tone (500, 1,000, 2,000, 4,000 Hz) air-conduction pure-tone average (PTA), bone-conduction PTA, air-bone gap and speech reception threshold, and preoperative to postoperative change in values. RESULTS We identified 247 patients (262 ears) who underwent repair. The mean and median ages were approximately 12 and 8.5 years, respectively, both of which served as cutoff ages to compare younger versus older patients. The average preoperative to postoperative improvement values in air-conduction PTA, air-bone gap, and speech reception threshold for individuals younger than 12 years were 26.6 ± 10.2, 23.8 ± 12.6, and 30.1 ± 12.1 dB hearing level (HL), respectively, and those for individuals 12 years or older were 25.9 ± 15.7, 26.2 ± 10.3, and 31.3 ± 12.8 dB HL, respectively. For individuals younger than 8.5 years, the values were 25.8 ± 9.5, 24.9 ± 9.4, and 30.0 ± 10.6 dB HL, respectively, and those for individuals 8.5 years or older were 27.1 ± 13.5, 25.7 ± 11.0, and 30.0 ± 14.6 dB HL, respectively. The improvement did not differ significantly between the younger and older groups, using both cutoff ages. There was no difference in revision surgery rates or complications between groups. CONCLUSION An individual at any age can enjoy audiometric improvement from atresia repair.
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Abstract
OBJECTIVE Compare surgical and audiological outcomes of patients with congenital aural stenosis (CAS) with cholesteatoma to patients with CAS without cholesteatoma and patients with complete congenital aural atresia (CCAA). STUDY DESIGN Retrospective case series. SETTING Tertiary care hospital. PATIENTS Patients with CAS (with and without cholesteatoma) and CCAA. INTERVENTION Surgery for CAS/CAA. MAIN OUTCOME MEASURES Patients with CAS and CAA undergoing surgical repair from June 2004 to July 2020 were identified from an institutional database. Included patients were divided by presence of a canal cholesteatoma. Clinical history, pre- and postoperative audiometric data, and clinical outcomes were compared. RESULTS Of the 283 patients (300 ears), 18 (19 ears) had a canal cholesteatoma. When compared to ears without cholesteatoma (CCAA ears plus CAS ears without cholesteatoma), ears with cholesteatoma were more likely to be younger (9.2 ± 6.6 vs. 11.5 ± 9.2; p = 0.015), female (66.7% vs. 38.1%; p = 0.02; OR 3.2, 95% CI 1.18-8.9), and have normal/Grade I microtia (47.4% vs. 9.6%; p < 0.0001; OR 0.12, 95% CI 0.044-0.32), but not a history of draining ear (5.3% vs. 0%; p = 0.05; OR 0.06, 95% CI 0.004-0.999). Preoperative audiometric data demonstrated a lower mean air-bone gap (45.8 dB vs. 52.3 dB; p = 0.009) and better speech reception threshold (48.7 dB vs. 57.4 dB; p = 0.0004) in cholesteatoma ears. Postoperatively, ears with cholesteatoma were more likely to close the ABG within 20 dB (p = 0.001; OR 0.19, 95% CI 0.072-0.52). No patient in the cholesteatoma group developed post-operative bony/soft-tissue stenosis (0% vs. 9.7%; p = 0.65; OR 1.61; 0.21-12.6) or required revision surgery (0% vs. 11%; p = 0.38; OR 2.46, 0.32-19). CONCLUSIONS Patients with CAS and cholesteatoma have better audiometric outcomes and likely a more durable repair with a decreased need for revision possibly secondary to greater embryologic development of the meatus, ear canal, and middle ear space despite the cholesteatoma.
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Affiliation(s)
- Geoffrey C Casazza
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
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Fourla NV, Chrysikos DT, Makrypidis KT, Memtsas ZA, Protogerou VD, Karamanidi MG, Troupis TT. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac037. [PMID: 35169441 PMCID: PMC8840870 DOI: 10.1093/jscr/rjac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
Congenital aural atresia refers to abnormal embryological development of the external auditory canal. The treatment of this anatomical malformation is only surgical repair. This article reports a case of unilateral congenital aural atresia, the surgical procedure performed and the post-operative findings.
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Affiliation(s)
- Natalia V Fourla
- Correspondence address. Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Goudi, Greece. Tel: (+30) 210 746 2002 - 3; E-mail:
| | - Dimosthenis T Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Goudi, Greece
| | | | - Zacharias A Memtsas
- Department of ENT, Euroclinic Athens, 7-9 Athanasiadou str., D. Soutsou, 11521, Athens, Greece
| | - Vasileios D Protogerou
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Goudi, Greece
| | - Maria G Karamanidi
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Goudi, Greece
| | - Theodore T Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias str., 11527 Goudi, Greece
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Lasminingrum L, Mahdiani S, Makerto RD. Surgical treatment of external auditory canal cholesteatoma in congenital malformation of the ear: A case series. Ann Med Surg (Lond) 2021; 70:102880. [PMID: 34691423 PMCID: PMC8519755 DOI: 10.1016/j.amsu.2021.102880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background External auditory canal (EAC) cholesteatoma is a lesion lined with stratified squamous epithelium containing proliferative keratin with bony erosion in EAC which can spread to the tympanic cavity, mastoid, and surrounding organ. External cholesteatoma can occur in patients with congenital abnormalities such as congenital aural atresia (CAA). Method This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2015–2020 period. Result 3 participants aged 10.67 ± 2.31 years with CAA had other complaints of ear infections. All participants experienced sensorineural hearing loss with an average threshold of 59.33 ± 36.68 dB and suspicious cholesteatoma from a CT scan. Canal wall down, meatoplasty, and/or canaloplasty were performed based on the findings. Conclusion Surgical procedure in CAA with cholesteatoma aimed on preventing further complications and recurrence. Congenital aural atresia (CAA) is a condition where the patent external auditory canal is not formed. Canaloplasty and meatoplasty is the management of congenital aural atresia (CAA). Canal wall down effective management of CAA with grade IV.
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Affiliation(s)
- Lina Lasminingrum
- Corresponding author. Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Pasteur, Sukajadi, Bandung, West Java, 40161, Indonesia.
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