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Qi F, You Z, Guo J, Hong Y, Wu X, Zhang D, Li Q, Cai C. An automatic diagnosis model of otitis media with high accuracy rate using transfer learning. Front Mol Biosci 2024; 10:1250596. [PMID: 38577506 PMCID: PMC10991843 DOI: 10.3389/fmolb.2023.1250596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
Introduction: Chronic Suppurative Otitis Media (CSOM) and Middle Ear Cholesteatoma are two common chronic otitis media diseases that often cause confusion among physicians due to their similar location and shape in clinical CT images of the internal auditory canal. In this study, we utilized the transfer learning method combined with CT scans of the internal auditory canal to achieve accurate lesion segmentation and automatic diagnosis for patients with CSOM and middle ear cholesteatoma. Methods: We collected 1019 CT scan images and utilized the nnUnet skeleton model along with coarse grained focal segmentation labeling to pre-train on the above CT images for focal segmentation. We then fine-tuned the pre-training model for the downstream three-classification diagnosis task. Results: Our proposed algorithm model achieved a classification accuracy of 92.33% for CSOM and middle ear cholesteatoma, which is approximately 5% higher than the benchmark model. Moreover, our upstream segmentation task training resulted in a mean Intersection of Union (mIoU) of 0.569. Discussion: Our results demonstrate that using coarse-grained contour boundary labeling can significantly enhance the accuracy of downstream classification tasks. The combination of deep learning and automatic diagnosis of CSOM and internal auditory canal CT images of middle ear cholesteatoma exhibits high sensitivity and specificity.
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Affiliation(s)
- Fangyu Qi
- Department of Anesthesiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Zhiyu You
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jiayang Guo
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Yongjun Hong
- Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Xiaolong Wu
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | | | - Qiyuan Li
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Chengfu Cai
- College of Otorhinolaryngology Head and Neck Surgery, Xiamen Haicang Hospital, Xiamen, China
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Pattabhi A, Pendem S, S D, Yuwanati M, Krishnan M. Cholesterol Granuloma From a Developmental Odontogenic Cyst: A Report of a Rare Case and a Literature Review. Cureus 2024; 16:e54545. [PMID: 38516497 PMCID: PMC10955371 DOI: 10.7759/cureus.54545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Dentigerous cysts are the second most common developmental odontogenic cysts that develop around the crown of unerrupted teeth with the maxillary canine region being one of the common sites of occurrence. The cystic lining of this lesion has been shown to develop into ameloblastoma, Muco epidermoid carcinoma, and squamous cell carcinomas. However, the development of cholesterol granuloma (CG) in the cystic lining of a dentigerous cyst is extremely rare. CG is a histological observation distinguished by the presence of a conglomeration of connective tissue and granulation tissue. The condition is predominantly seen in the field of otolaryngology, with very few cases reported in the maxillofacial region, most of which are associated with the maxillary sinus. This article presents the findings of a CG in a 39-year-old male patient that developed within the dentigerous cyst and discusses the possible etiopathogenesis, surgical management, and histological presentation.
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Affiliation(s)
- Ashwin Pattabhi
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sneha Pendem
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Dharini S
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Monal Yuwanati
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Carasek N, Cristovão D, Oliveira LAT, Caldas FF, Correia FM, Elias TGA, Amorim R, Bahmad Jr F. Middle Ear Cholesteatoma and Vestibular Schwannoma Resection Followed by Cochlear Implant: Surgical Challenges and Audiological Outcomes. J Clin Med 2023; 12:7139. [PMID: 38002751 PMCID: PMC10672219 DOI: 10.3390/jcm12227139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The occurrence of vestibular schwannoma (VS) associated with cholesteatoma is rare. A hearing impairment is one of the most significant issues in such cases. Moreover, the presence of middle and inner ear pathologies combined may represent a surgical challenge. No studies have described a combined surgical approach for these coexisting conditions (VS and cholesteatoma), nor the hearing rehabilitation outcomes of using cochlear implants for these patients. (2) Case Report: This paper is on a female patient who underwent simultaneous surgical treatments for VS and middle ear cholesteatoma in the right ear followed by a cochlear implant, describing the technique and the audiological results. (3) Conclusions: The surgical approach was successful and enabled the resection of lesions with the auditory nerve and cochlea preservation. Cochlear implantation in the right ear showed positive postoperative results, with an improvement in the results with the CI in silent and noisy environments.
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Affiliation(s)
- Natalia Carasek
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Danielle Cristovão
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | - Lucas Alves Teixeira Oliveira
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
| | | | - Fernando Massa Correia
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
| | | | - Rivadávio Amorim
- Faculty of Medical Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil
| | - Fayez Bahmad Jr
- Faculty of Health Sciences, University of Brasília, Federal District, Brasilia 70910-900, Brazil; (N.C.); (D.C.); (L.A.T.O.)
- Brazilian Institute of Otorhinolaryngology, Federal District, Brasília 70710-149, Brazil
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Lei Y, An J, Ren Q, Wang M, Gao M. Expression of MMP-14 and its role in bone destruction in middle ear cholesteatoma: A prospective observational study. Medicine (Baltimore) 2023; 102:e35538. [PMID: 37904429 PMCID: PMC10615539 DOI: 10.1097/md.0000000000035538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/15/2023] [Indexed: 11/01/2023] Open
Abstract
Cholesteatoma is a noncancerous cystic lesion caused by an abnormal growth of keratinizing squamous epithelium which is invasive and capable of destroying structures. A prospective study on the expression of membrane type1-matrix metalloproteinases (MMP-14) and its related influencing factors in middle ear cholesteatoma was conducted to fully understand the pathogenesis of cholesteatoma in the molecular level. We examined the expression of MMP-14 by immunohistochemical staining 39 middle ear cholesteatoma specimens and 10 external auditory meatus epithelial cell specimens. The cholesteatoma specimens were divided into 4 groups according to the degree of destruction of the ossicles during surgery. The associated factors affecting MMP-14 expression were analyzed using statistical methods; The positive expression of MMP-14 in the epithelium of the external auditory canal was significantly different between middle ear cholesteatoma and normal patients (P < .05); Gender, age, and the degree of hearing loss had no statistically significant effect on MMP-14 expression (P > .05); The expression of MMP-14 was positively correlated with the severity of bone destruction (R = 0.535, P < .05); MMP-14 plays an important role in the pathological development of the epithelium of cholesteatoma; MMP-14 expression in middle ear cholesteatoma tissue was not strongly correlated with the level of hearing loss, age or gender, but was positively correlated with the degree of middle ear bone destruction.
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Affiliation(s)
- Yu Lei
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Junjun An
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingchun Ren
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minjun Wang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mingzhu Gao
- Department of Otorhinolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Xie S, Jin L, He J, Fu J, Yin T, Ren J, Liu W. Analysis of mRNA m 6A modification and mRNA expression profiles in middle ear cholesteatoma. Front Genet 2023; 14:1188048. [PMID: 37609036 PMCID: PMC10441234 DOI: 10.3389/fgene.2023.1188048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction: Middle ear cholesteatoma is characterized by the hyperproliferation of keratinocytes. In recent decades, N6-methyladenosine (m6A) modification has been shown to play an essential role in the pathogenesis of many proliferative diseases. However, neither the m6A modification profile nor its potential role in the pathogenesis of middle ear cholesteatoma has currently been investigated. Therefore, this study aimed to explore m6A modification patterns in middle ear cholesteatoma. Materials and methods: An m6A mRNA epitranscriptomic microarray analysis was performed to analyze m6A modification patterns in middle ear cholesteatoma tissue (n = 5) and normal post-auricular skin samples (n = 5). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to predict the potential biological functions and signaling pathways underlying the pathogenesis of middle ear cholesteatoma. Subsequently, m6A modification levels were verified by methylated RNA immunoprecipitation-qPCR (MeRIP-qPCR) in middle ear cholesteatoma tissue and normal skin samples, respectively. Results: A total of 6,865 distinctive m6A-modified mRNAs were identified, including 4,620 hypermethylated and 2,245 hypomethylated mRNAs, as well as 9,162 differentially expressed mRNAs, including 4,891 upregulated and 4,271 downregulated mRNAs, in the middle ear cholesteatoma group relative to the normal skin group. An association analysis between methylation and gene expression demonstrated that expression of 1,926 hypermethylated mRNAs was upregulated, while expression of 2,187 hypomethylated mRNAs and 38 hypermethylated mRNAs was downregulated. Moreover, GO analysis suggested that differentially methylated mRNAs might influence cellular processes and biological behaviors, such as cell differentiation, biosynthetic processes, regulation of molecular functions, and keratinization. KEGG pathway analysis demonstrated that the hypermethylated transcripts were involved in 26 pathways, including the Hippo signaling pathway, the p53 signaling pathway, and the inflammatory mediator regulation of transient receptor potential (TRP) channels, while the hypomethylated transcripts were involved in 13 pathways, including bacterial invasion of epithelial cells, steroid biosynthesis, and the Hippo signaling pathway. Conclusion: Our study presents m6A modification patterns in middle ear cholesteatoma, which may exert regulatory roles in middle ear cholesteatoma. The present study provides directions for mRNA m6A modification-based research on the epigenetic etiology and pathogenesis of middle ear cholesteatoma.
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Affiliation(s)
- Shumin Xie
- Hunan Provincial Key Lab, Department of Otolaryngology-Head and Neck Surgery, The Xiangya Hospital, Otolaryngology Institute of Major Diseases, Central South University, Changsha, Hunan, China
| | - Li Jin
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jun He
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jinfeng Fu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuanfang Yin
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jihao Ren
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Kapoor AA, Kapoor A, Nimkar NU, Soni HD, Ojha VS, Biswas R. High-Resolution Computed Tomography and Intraoperative Correlation in Cholesteatoma: Enhancing Preoperative Evaluation and Surgical Management. Cureus 2023; 15:e44333. [PMID: 37779786 PMCID: PMC10538802 DOI: 10.7759/cureus.44333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Cholesteatoma, a hazardous non-neoplastic lesion of the temporal bone, is prevalent in socio-economically disadvantaged groups in developing nations like India. Timely detection and surgical intervention are essential for effective management. High-resolution computed tomography (HRCT) has revolutionized the assessment of temporal bone pathology, though its role in preoperative evaluation remains debated. This study aimed to validate HRCT's utility in diagnosing cholesteatoma, compare its findings with intraoperative observations, and assess sensitivity and specificity. METHODS This diagnostic accuracy study was conducted at a tertiary care center in Western India, from March 2021 to November 2022. HRCT findings of 54 cholesteatoma patients were evaluated and compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient were calculated. RESULTS HRCT demonstrated a sensitivity exceeding 90% in identifying scutum erosion, mastoid sclerosis, and abnormalities in the tympanic membrane, along with a specificity surpassing 90% in detecting various conditions, including facial canal erosion, sinus plate erosion, lateral semicircular canal erosion, erosion of the posterior wall of the external auditory canal, and abnormalities in the tympanic membrane. Furthermore, HRCT exhibited an accuracy of over 90% in detecting most pathologies. There was a perfect or near-perfect agreement observed for abnormal tympanic membrane, sinus plate erosion, mastoid sclerosis, and erosion of the posterior wall of the external auditory canal (with kappa values > 0.8). Moderate to fair agreement was noted for other pathologies. CONCLUSION HRCT offered precise detection of the majority of pathologies, thereby facilitating surgical planning. However, the presence of limitations in distinguishing specific abnormalities highlights the significance of utilizing HRCT in tandem with other diagnostic modalities to ensure meticulous diagnosis and effective treatment planning.
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Affiliation(s)
- Abha A Kapoor
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Abhay Kapoor
- Department of Internal Medicine, B.J. Medical College, Ahmedabad, Ahmedabad, IND
| | - Nimisha U Nimkar
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Hiren D Soni
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Vishnu S Ojha
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Ratnadeep Biswas
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
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林 锋, 吴 倩, 张 毅, 戴 春. [A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:670-672. [PMID: 37551579 PMCID: PMC10645530 DOI: 10.13201/j.issn.2096-7993.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Indexed: 08/09/2023]
Abstract
Delayed endolymphatic hydrops (DEH) is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula (LF); however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.
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Affiliation(s)
- 锋 林
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科 国家卫生健康委员会听觉医学重点实验室(上海,200031)Department of Otorhinolaryngology, Fudan University Eye and ENT Hospital, Key Laboratory of Auditory Medicine of the National Health Commission, Shanghai, 200031, China
| | - 倩如 吴
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科 国家卫生健康委员会听觉医学重点实验室(上海,200031)Department of Otorhinolaryngology, Fudan University Eye and ENT Hospital, Key Laboratory of Auditory Medicine of the National Health Commission, Shanghai, 200031, China
| | - 毅博 张
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科 国家卫生健康委员会听觉医学重点实验室(上海,200031)Department of Otorhinolaryngology, Fudan University Eye and ENT Hospital, Key Laboratory of Auditory Medicine of the National Health Commission, Shanghai, 200031, China
| | - 春富 戴
- 复旦大学附属眼耳鼻喉科医院耳鼻咽喉科 国家卫生健康委员会听觉医学重点实验室(上海,200031)Department of Otorhinolaryngology, Fudan University Eye and ENT Hospital, Key Laboratory of Auditory Medicine of the National Health Commission, Shanghai, 200031, China
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Nishimura R, Miuchi S, Ikehata M, Sakagami M, Tsuzuki K. Change in chorda tympani nerve function after two-stage tympanoplasty for cholesteatoma. Laryngoscope Investig Otolaryngol 2022; 7:2035-2042. [PMID: 36544921 PMCID: PMC9764802 DOI: 10.1002/lio2.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Chorda tympani nerve (CTN) function may be damaged more by two-stage than by one-stage surgery for middle ear cholesteatoma. However, few studies have reported the relationship between two-stage cholesteatoma surgery and CTN function. This study aimed to investigate CTN function after two-stage surgery for cholesteatoma. Methods In this prospective study, 35 patients underwent two-stage canal wall up tympanoplasty (CWUT). Perioperative CTN function was assessed using questionnaires and electrogustometry (EGM). Participants were categorized into minor, major, and section groups, based on the degree of CTN manipulation during surgery. Results In the first-stage surgery, posterior tympanotomy with an intact canal wall reduced the degree of CTN manipulation. The incidence of taste disorder after the first-stage surgery was 71.4%. Postoperative taste disorder and the EGM threshold improved early in the minor manipulation group. In the second-stage surgery, no new CTN damage occurred, even if this surgery involved removal of residual cholesteatoma. The incidence of taste disorder after second-stage surgery was less than that after first-stage surgery, independent of CTN preservation. However, the recovery rate of the EGM threshold after second-stage surgery was significantly lower in the section group than in those with CTN preservation. Conclusion CTN function, including symptoms and EGM threshold, can be preserved during two-stage cholesteatoma surgery if care is taken to preserve the CTN in both the first- and second-stage surgeries. A two-stage CWUT, ensuring an intact bony annulus, may be effective to facilitate CTN preservation. Level of Evidence 2b.
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Affiliation(s)
- Riu Nishimura
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Shinya Miuchi
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Miki Ikehata
- Department of OtolaryngologyAmagasaki Chuo HospitalHyogoJapan
| | - Masafumi Sakagami
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
| | - Kenzo Tsuzuki
- Department of Otorhinolaryngology – Head and Neck SurgeryHyogo Medical UniversityHyogoJapan
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Su R, Song J, Wang Z, Mao S, Mao Y, Wu X, Hou M. Application of high resolution computed tomography image assisted classification model of middle ear diseases based on 3D-convolutional neural network. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1037-1048. [PMID: 36097771 PMCID: PMC10950109 DOI: 10.11817/j.issn.1672-7347.2022.210704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Chronic suppurative otitis media (CSOM) and middle ear cholesteatoma (MEC) are the 2 most common chronic middle ear diseases. In the process of diagnosis and treatment, the 2 diseases are prone to misdiagnosis and missed diagnosis due to their similar clinical manifestations. High resolution computed tomography (HRCT) can clearly display the fine anatomical structure of the temporal bone, accurately reflect the middle ear lesions and the extent of the lesions, and has advantages in the differential diagnosis of chronic middle ear diseases. This study aims to develop a deep learning model for automatic information extraction and classification diagnosis of chronic middle ear diseases based on temporal bone HRCT image data to improve the classification and diagnosis efficiency of chronic middle ear diseases in clinical practice and reduce the occurrence of missed diagnosis and misdiagnosis. METHODS The clinical records and temporal bone HRCT imaging data for patients with chronic middle ear diseases hospitalized in the Department of Otorhinolaryngology, Xiangya Hospital from January 2018 to October 2020 were retrospectively collected. The patient's medical records were independently reviewed by 2 experienced otorhinolaryngologist and the final diagnosis was reached a consensus. A total of 499 patients (998 ears) were enrolled in this study. The 998 ears were divided into 3 groups: an MEC group (108 ears), a CSOM group (622 ears), and a normal group (268 ears). The Gaussian noise with different variances was used to amplify the samples of the dataset to offset the imbalance in the number of samples between groups. The sample size of the amplified experimental dataset was 1 806 ears. In the study, 75% (1 355) samples were randomly selected for training, 10% (180) samples for validation, and the remaining 15% (271) samples for testing and evaluating the model performance. The overall design for the model was a serial structure, and the deep learning model with 3 different functions was set up. The first model was the regional recommendation network algorithm, which searched the middle ear image from the whole HRCT image, and then cut and saved the image. The second model was image contrast convolutional neural network (CNN) based on twin network structure, which searched the images matching the key layers of HRCT images from the cut images, and constructed 3D data blocks. The third model was based on 3D-CNN operation, which was used for the final classification and diagnosis of the 3D data block construction, and gave the final prediction probability. RESULTS The special level search network based on twin network structure showed an average AUC of 0.939 on 10 special levels. The overall accuracy of the classification network based on 3D-CNN was 96.5%, the overall recall rate was 96.4%, and the average AUC under the 3 classifications was 0.983. The recall rates of CSOM cases and MEC cases were 93.7% and 97.4%, respectively. In the subsequent comparison experiments, the average accuracy of some classical CNN was 79.3%, and the average recall rate was 87.6%. The precision rate and the recall rate of the deep learning network constructed in this study were about 17.2% and 8.8% higher than those of the common CNN. CONCLUSIONS The deep learning network model proposed in this study can automatically extract 3D data blocks containing middle ear features from the HRCT image data of patients' temporal bone, which can reduce the overall size of the data while preserve the relationship between corresponding images, and further use 3D-CNN for classification and diagnosis of CSOM and MEC. The design of this model is well fitting to the continuous characteristics of HRCT data, and the experimental results show high precision and adaptability, which is better than the current common CNN methods.
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Affiliation(s)
- Ri Su
- School of Mathematics and Statistics, Central South University, Changsha 410083.
| | - Jian Song
- Department of Otorhinolaryngology, Xiangya Hospital, Central South University, Changsha 410008.
- Hunan Provincial Key Laboratory of Major Otorhinolaryngology Diseases, Changsha 410008.
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008.
| | - Zheng Wang
- School of Mathematics and Statistics, Central South University, Changsha 410083
| | - Shuang Mao
- Department of Otorhinolaryngology, Xiangya Hospital, Central South University, Changsha 410008
- Hunan Provincial Key Laboratory of Major Otorhinolaryngology Diseases, Changsha 410008
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008
| | - Yitao Mao
- Department of Imaging, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xuewen Wu
- Department of Otorhinolaryngology, Xiangya Hospital, Central South University, Changsha 410008
- Hunan Provincial Key Laboratory of Major Otorhinolaryngology Diseases, Changsha 410008
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Changsha 410008
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha 410083
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徐 继, 蒋 雯, 刘 洁, 王 浩, 赵 泽, 刘 稳, 李 巍. [Characteristics and differential diagnosis of middle ear cholesteatoma and chronic suppurative otitis media with wideband acoustic immittance]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:376-381. [PMID: 35483690 PMCID: PMC10128251 DOI: 10.13201/j.issn.2096-7993.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Indexed: 06/14/2023]
Abstract
Objective:Through analysis of the sound energy absorbance of wideband acoustic immittance to provide a basis for differential diagnosis of adult acquired secondary cholesteatoma of the middle ear and patients with chronic suppurative otitis media(CSOM). Methods:38 cases of cholesteatoma and 40 cases of CSOM admitted to the Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2021 were selected as the research group, and 30 cases (60 ears) of normal adults were selected as the control group. A total of 16 frequency points were selected, and the energy absorbance of wideband acoustic immittance was taken as the research parameter. The characteristics of energy absorbance under ambient pressure among the three are compared. Then the ROC in the cholesteatoma group was drawn, and by calculating the AUC, the Cut-off values and the corresponding sensitivity and specificity were found. Results:The energy absorbance in CSOM group at 1100-5700 Hz and the cholesteatoma group at 560-5700 Hz was lower than that in the control group, and the difference in some frequency bands was statistically significant. The energy absorbance in the cholesteatoma group at 226-7100 Hz was lower than that in the CSOM group, and the difference between the two groups in many frequency points was statistically significant. The ROC in the research group was drawn and it was found that the AUC in the 560, 710, 890, and 4500 bands was > 0.5, and in the other bands was > 0.7(P<0.05). The AUC in the 2800 Hz was the largest (0.78), the Cut-off value was 0.31, the corresponding sensitivity was 78.38%, specificity was 73.33%. Conclusion:Wideband acoustic immittance can be used as an auxiliary method for the differential diagnosis of adult-acquired secondary cholesteatoma of the middle ear and chronic suppurative otitis media in adults.
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Affiliation(s)
- 继峰 徐
- 徐州医科大学第一临床医学院(江苏徐州,221000)First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, 221000, China
| | - 雯 蒋
- 徐州医科大学附属医院耳鼻咽喉科Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University
| | - 洁 刘
- 徐州医科大学医学技术学院College of Medical Technology, Xuzhou Medical University
| | - 浩 王
- 徐州医科大学第一临床医学院(江苏徐州,221000)First College of Clinical Medicine, Xuzhou Medical University, Xuzhou, 221000, China
| | - 泽祺 赵
- 徐州医科大学附属医院耳鼻咽喉科Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University
| | - 稳 刘
- 徐州医科大学附属医院耳鼻咽喉科Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University
| | - 巍 李
- 徐州医科大学附属医院耳鼻咽喉科Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University
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Li C, Wang B, Zhang H, Yang S, Yang T, Han X, Liu H, Zhang W. [Advances in the surgical treatment of cholesteatoma of the middle ear]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:952-956. [PMID: 34628824 PMCID: PMC10127695 DOI: 10.13201/j.issn.2096-7993.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Indexed: 11/12/2022]
Abstract
Middle ear cholesteatoma, as a common ear disease, has been further understood in terms of its molecular mechanism, classification and staging, and it is generally believed that surgical treatment is the first choice, but there is no final conclusion on its surgical choice. Microscopic surgery includes complete or open radical mastoidectomy with or without reconstruction of the middle ear cavity, and their pros and cons have been debated for decades. In the past decade, a variety of surgical methods have been developed, including various improvements and combined operations that combine the advantages of traditional open radical mastoidectomy and complete mastoidectomy. On the other hand, the emergence of ear endoscopic surgery has opened up new surgical methods, as well as the use of laser and other new technologies to improve the surgical effect and prognosis, but also can not avoid their limitations and shortcomings. The purpose of this paper is to summarize the advantages and disadvantages of various surgical treatments for middle ear cholesteatoma in order to provide guidance and help for otologists in the treatment of middle ear cholesteatoma.
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Burgos MA, Pardo A, Rodríguez R, Rodríguez-Balbuena B, Castro D, Piqueras F, Esteban F. Linking Chronic Otitis Media and Nasal Obstruction: A CFD Approach. Laryngoscope 2021; 132:1224-1230. [PMID: 34585755 DOI: 10.1002/lary.29882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/18/2021] [Accepted: 08/28/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate a possible relationship between altered nasal flow and chronic otitis media (COM) using computational fluid dynamics (CFD). STUDY DESIGN Retrospective case series. METHODS Retrospective cohort sample of CT scans from patients with COM and controls without COM to compare the results of various nasal airflow parameters determined by CFD between a group of patients with COM (N = 60) and a control group of subjects without any evidence of ear disease (N = 81). The CT were subjected to various procedures to carry out CFD studies, determining the resistance to nasal flow, the proportion of flow through the right and left nasal cavity, and two nondimensional estimators. The results of CFD studies between patients with COM and controls were compared. RESULTS Whereas only 12.3% of the controls had CFD alteration (10 out of 81), 43.3% of the patients suffering COM displayed alterations of our nondimensional parameters R - ϕ (26 out of 60). CONCLUSIONS According to our results, the incidence of alterations in nasal airflow by studying with CFD is significantly higher in patients with COM than in controls. To our knowledge, this is the first article linking nasal cavity and COM using a CFD approach. Our results support the hypothesis that nasal flow alterations could be implicated in the etiopathogenesis of the COM. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
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Affiliation(s)
- Manuel A Burgos
- Departamento de Ingeniería Térmica y de Fluidos, Universidad Politécnica de Cartagena, Cartagena, Spain
| | | | - Rafael Rodríguez
- Hospital Universitario Virgen del Rocío, Servicio de Radiodiagnóstico, Servicio Andaluz de Salud, Sevilla, Spain
| | - Beatriz Rodríguez-Balbuena
- Hospital Universitario Virgen del Rocío, Servicio de Otorrinolaringología, Universidad de Sevilla, Sevilla, Spain
| | - David Castro
- Hospital Universitario Virgen del Rocío, Servicio de Otorrinolaringología, Universidad de Sevilla, Sevilla, Spain
| | - Francisco Piqueras
- Servicio de Otorrinolaringología, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Francisco Esteban
- Hospital Universitario Virgen del Rocío, Servicio de Otorrinolaringología, Universidad de Sevilla, Sevilla, Spain
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Zuo Q, Zhang K, Ma F, Pan T, Song W. [Causes analysis of mastoid cavity infection after mastoidectomy and key techniques of revision mastoidectomy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:521-524. [PMID: 34304511 PMCID: PMC10128604 DOI: 10.13201/j.issn.2096-7993.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 11/12/2022]
Abstract
Objective:To analyze the causes of infected mastoid cavity after mastoidectomy and explore the key techniques of revision mastoidectomy. Methods:Ninety-two patients, who underwent revision mastoidectomy due to mastoid cavity infection after mastoidectomy were retrospectively analyzed. There were 56 cases of canal wall up mastoidectomy plus tympanoplasty and 36 cases of canal wall down mastoidectomy plus tympanoplasty in previous surgery. The interval between the previous operation and this revision ranged from 7 months to 50 years, with a median of 9 years. By reviewing the general clinical data, preoperative HRCT scan of temporal bone and intraoperative findings, the defects of the previous operation and the region of the lesion were analyzed and counted. Results:Out of the 92 cases, 7 cases(7.6%) had sigmoid sinus antedisplacement and low-lying middle cranial fossa, and 45 cases(48.9%) with facial nerve canal loss. Among the 36 patients who underwent canal wall down mastoidectomy and tympanoplasty, mastoid cells were removed in completely; 26 patients had high facial ridge, accounting for 72.2%(26/36). The defects of the previous operation included: stenosis of external auditory meatus(65/92, 70.7%), obstruction of Eustachian tube(11/92, 12.0%), and tympanitis(2/92, 2.2%). Residual or recurrent lesions were most common in mastoid process and tympanic sinus(50/92, 54.3%), followed by attic cell and anterior cavity(44/92, 47.8%), posterior tympanic cavity(29/92, 31.5%), perilabyrinthine cells(13/92, 14.1%), sinus meningeal angle(13/92, 14.1%), cells behind the facial nerve(12/92, 13.0%), Eustachian tube(10/92, 10.9%), and hypotympanum(9/92, 9.8%). Conclusion:The main causes of mastoid cavity infecion after mastoidectomy include incomplete removal of the lesion and inadequate drainage conditions. The key techniques of revisional mastoidectomy include disc-shaped operative cavity, skeletonization of mastoid process, reduction of facial nerve ridge, management of Eustachian tube and conchaplasty. The above techniques are also key in the first operation in order to improve the success rate of operation and avoid revision operation.
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Affiliation(s)
- Qiang Zuo
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - Ke Zhang
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - Furong Ma
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - Tao Pan
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
| | - Weiming Song
- Department of Otolaryngology Head and Neck Surgery,Peking University Third Hospital,Beijing,100191,China
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Hou Z, Wang F, Zuo W, Liu Y, Wang W, Hou K, Jia J, Yang S. Application of a novel transcanal keyhole technique in endoscopic cholesteatoma surgery. Acta Otolaryngol 2021; 141:328-333. [PMID: 33502273 DOI: 10.1080/00016489.2021.1871777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is difficult to deal with epitympanic cholesteatoma in otologic surgery. The keyhole technique can realize minimally invasive surgery and reconstruct the middle ear canal. OBJECTIVE To explore the clinical application of keyhole technique in primary and second-look surgery in middle ear cholesteatoma. MATERIALS AND METHODS 34 cases were analyzed retrospectively in terms of residual and recurrence rate, safety (adverse events) and hearing performance at long-term follow-up. The application of the technique in primary or second stage operation was evaluated and the operation was performed by transanal endoscopy or combined approach. RESULTS The cholesteatoma revealed by CT before operation was limited to the attic in 23 patients, of which 16 had the same imaging range as that of the keyhole technique. The preoperative imaging findings of 11 showed that the attic cholesteatoma may have extended into the mastoid, of which only 6 cases were confirmed by keyhole technique. An endoscopic second-look surgery using the keyhole technique was performed for these patients, 2 were confirmed to have residual lesions in the attic. CONCLUSIONS The keyhole technique under otoendoscopy can be used flexibly and conveniently in the second-look surgery to make up for the shortage of diffusion-weighted magnetic resonance imaging.
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Affiliation(s)
- Zhaohui Hou
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Fangyuan Wang
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Wenjing Zuo
- Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Ya Liu
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Wenjia Wang
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Kun Hou
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Jianping Jia
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
| | - Shiming Yang
- ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- Key Lab of Hearing Science, Ministry of Education, China
- Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, China
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Abstract
BACKGROUND Endoscopy has been increasingly used in middle ear cholesteatoma surgery. It can increase the proportion of canal wall up (CWU) surgery and effectively control the recurrence and residual rates. However, there is a lack of systematic description on scutum reconstruction technique in endoscopic middle ear cholesteatoma surgery. OBJECTIVE The technique and classification of scutum reconstruction in endoscopic cholesteatoma surgery were proposed, and the outcomes were preliminarily evaluated. METHODS According to the development of mastoid and the way of hearing reconstruction, the reconstruction of scutum was classified into three types. The rates of residual and recurrence and hearing outcomes were observed and analyzed. RESULTS A total of 57 patients underwent endoscopic cholesteatoma surgery, all of which were CWU surgery. The reconstruction of the scutum was performed using tragal cartilage according to three types. The residual of cholesteatoma was observed in three cases. The recurrence of cholesteatoma and retraction pocket was detected in two cases and five cases, respectively. Postoperative hearing results were generally satisfied in all three types of surgeries. CONCLUSION The technique of scutum reconstruction in endoscopic cholesteatoma surgery in this work can effectively control the recurrent disease after CWU surgery.
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Affiliation(s)
- Nan Wu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Wenjing Zuo
- Medical School, Nankai University, Tianjin, China
| | - Fangyuan Wang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Kun Hou
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Shiming Yang
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
| | - Zhaohui Hou
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, State Key Lab of Hearing Science, Ministry of Education, Beijing, China
- Beijing Key Lab of Hearing Impairment Prevention and Treatment, Beijing, China
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Liu T, Xie JH, Su J, Li P. [Analysis of transcanal endoscopic ear surgery for antrum cholesteatoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:70-72;78. [PMID: 32086903 PMCID: PMC10128591 DOI: 10.13201/j.issn.1001-1781.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 11/12/2022]
Abstract
Objective:To report surgical techniques, outcomes, clinical experience and application key point of transcanal endoscopic ear surgery for tympanic antrum cholesteatoma. Method:Data from 27patients who underwent transcanal endoscopic ear surgery for tympanic antrum cholesteatoma were retrospectively analyzed. Removal of tympanic antrum cholesteatoma and tympanoplasty were individualized. Patients were followed up at postoperative 1, 3 and 6month. Result:There was no failure of tympanal and canal wall reconstruction. The mean preoperative air conduction threshold was(50.33±7.34) dB HL, compared to(29.59±5.56) dB HL postoperatively P=0.00). The mean preoperative air-bone gap was(29.13±4.70) dB, compared to(12.25±4.98) dB postoperatively(P=0.00). There was no complication, recurrence, residual tympanic antrum cholesteatoma or secondary surgery needed. Conclusion:Stand alone transcanal endoscopic ear surgery is a safe and effective for tympanic antrum cholesteatoma.
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Affiliation(s)
- T Liu
- Department of Otorhinolaryngology Head and Neck Surgery,Guangzhou First People's Hospital,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China
| | - J H Xie
- Department of Otorhinolaryngology Head and Neck Surgery,Guangzhou First People's Hospital,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China
| | - J Su
- Department of Otorhinolaryngology Head and Neck Surgery,Guangzhou First People's Hospital,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China
| | - P Li
- Department of Otorhinolaryngology Head and Neck Surgery,Guangzhou First People's Hospital,Second Affiliated Hospital of South China University of Technology,Guangzhou,510180,China
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Wu Q, Peng JJ, Zheng H. [Effects of preoperative secretions on dry ears after the surgery for chronic suppurative otitis media and cholesteatoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:398-401. [PMID: 31163544 DOI: 10.13201/j.issn.1001-1781.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the influences of preoperative secretions of the patients with chronic suppurative otitis media and/or middle ear cholesteatoma on the time to have dry ears after the operations. Method: The study enrolled 228 patients with chronic suppurative otitis media and/or middle ear cholesteatoma who received modified radical mastoidectomies and tympanoplasty. The patients were divided into two groups based on whether there were secreions in the surgical ear before the operations. The time to have dry ears after surgeries were compared between the two groups. Result: The time to have dry-ear postoperatively was significantly different between patients with different preoperative microbial types of surgical ear secretions(P<0.05). The dry ear time was(2.24±1.83) months in the secretion-free group, (2.22±1.96) months in the normal bacteria group of oral cavity and skin,(3.00±2.51) months in the single non-resistant bacteria group, (3.82±2.78) months in the fungal group and (6.82±1.83) months in the compound or multi-drug resistant bacteria group. The dry ear time of compound bacteria group or multi-drug resistant bacteria group was significantly longer than that of the other groups(P<0.05). The time to have dry ears of the fungus group was longer than that of the non-drug resistant bacteria, the normal oral and skin flora and the secretion free group(P<0.05). Chi-square test results showed that there was a significant difference in postoperative dry ear rate among patients with different preoperative secretions classification(P<0.05). Conclusion: The presence of secretion and microorganism type in ear before operation is an important influencing factor of postoperative time to have dry ears. Microbiological culture and appropriate medication based on the drug sensitivity tests are beneficial for the postoperative recovery of patients with chronic suppurative otitis media and/or middle ear cholesteatoma.
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Affiliation(s)
- Q Wu
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, 610041,China
| | - J J Peng
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, 610041,China
| | - H Zheng
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, 610041,China
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Song SP, Li WW, Ma XL. [Advances in research on apoptosis in the pathogenesis of acquired middle ear cholesteatoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 33:572-576. [PMID: 31163540 DOI: 10.13201/j.issn.1001-1781.2019.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Indexed: 11/12/2022]
Abstract
Summary Squamous epithelial hyperplasia, cell apoptosis and bone destruction were thought to be three key mechanisms in the pathogenesis of middle ear cholesteatoma. At present, the research on the pathogenesis of middle ear cholesteatoma mainly focuses on these three major pathological events. Studies have shown that various apoptosis-related genes and regulatory factors are associated with the development of cholesteatoma.
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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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Long RQ, Ruan B, Liu ZH, Li SL, Zhang F, Yang J, Gao JY. [The technique of retaining part of the external auditory canal posterior wall with epitympanoplasty in soft wall reconstruction treating middle ear cholesteatoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:23-27. [PMID: 29798205 DOI: 10.13201/j.issn.1001-1781.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the surgical treatment of cholesteatoma of the middle ear. Method:A retrospective analysis of patients from June 2013 to July 2016 diagnosed as cholesteatoma. 137 ears were divided into A group (retaining part of the external auditory canal posterior wall with epitympanoplasty in soft wall reconstruction for 75 ears) and B group (canal wall down mastoidotympanoplasty for 62 ears). the extent and damage of cholesteatoma were observed, comparing the time of dry ear and epithelial postoperative, the incidence of complications such as dizziness and hearing changes. Result:compared with B group, the postoperative dry ear time, epithelial time and hearing improvement in the A group were obviously improved, and the incidence of vertigo after operation was decreased, and the anatomical and physiological functions of the external auditory canal were protected. Conclusiont:The technique of retaining part of the external auditory canal posterior wall with epitympanoplasty in soft wall reconstruction is conductive to the removal of lesions and normal anatomical and physiological protection to external auditory canal, can prevent the forming of the abstraction pocket effectively and the recurrence of cholesteatoma, has clinical and practical value.
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Affiliation(s)
- R Q Long
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - B Ruan
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - Z H Liu
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - S L Li
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - F Zhang
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - J Yang
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
| | - J Y Gao
- Department of Otolaryngology, the First Hospital of Kunming Medical University, Kunming, 650032, China
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Yamamoto-Fukuda T, Akiyama N, Takahashi M, Kojima H. Keratinocyte Growth Factor (KGF) Modulates Epidermal Progenitor Cell Kinetics through Activation of p63 in Middle Ear Cholesteatoma. J Assoc Res Otolaryngol 2018; 19:223-241. [PMID: 29549594 DOI: 10.1007/s10162-018-0662-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/28/2018] [Indexed: 01/27/2023] Open
Abstract
The basal stem/progenitor cell maintains homeostasis of the epidermis. Progressive disturbance of this homeostasis has been implicated as a possible cause in the pathogenesis of epithelial disease, such as middle ear cholesteatoma. In many cases of stem/progenitor cell regulation, the importance of extracellular signals provided by the surrounding cells is well-recognized. Keratinocyte growth factor (KGF) is a mesenchymal-cell-derived paracrine growth factor that specifically participates in skin homeostasis; however, the overexpression of KGF induces middle ear cholesteatoma. In this study, two kinds of thymidine analogs were transferred at different time points and we investigated the effects of overexpressed KGF on the cell kinetics of stem/progenitor cells in vivo. As a result, BrdU(+)EdU(+) cells (stem/progenitor cells) were detected in the thickened epithelium of KGF-transfected specimens. The use of a high-resolution microscope enabled us to analyze the phosphorylated level of p63 in individual nuclei, and the results clearly demonstrated that BrdU(+)EdU(+) cells are regarded as progenitor cells. In the overexpression of KGF, the stimulation of progenitor cell proliferation was inhibited by SU5402, an inhibitor for tyrosine kinase of KGFR. These findings indicate that KGF overexpression may increase stem/progenitor cell proliferation and block terminal differentiation, resulting in epithelial hyperplasia, which is typical in middle ear cholesteatoma.
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Affiliation(s)
- Tomomi Yamamoto-Fukuda
- Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan. .,Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Naotaro Akiyama
- Department of Histology and Cell Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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22
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Akiyama N, Yamamoto-Fukuda T, Yoshikawa M, Kojima H. Evaluation of YAP signaling in a rat tympanic membrane under a continuous negative pressure load and in human middle ear cholesteatoma. Acta Otolaryngol 2017; 137:1158-1165. [PMID: 28708445 DOI: 10.1080/00016489.2017.1351040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Mechanotransduction plays an important role in cell-proliferative activities. Negative pressure in the middle ear is thought to be an important factor related to the etiology of acquired middle ear cholesteatoma. However, the correlation between negative pressure in the middle ear and the mechanism of middle ear cholesteatoma formation remains unclear. In this study, we investigated the expression of key molecules for mechanotransduction immunohistochemically. METHODS An immunohistochemical analysis was performed using anti-Wnt5a (a marker of alternative Wnt signaling), -Yes-associated protein (YAP) (a marker of mechanosensing) and -pYAP (phosphorylated YAP at Ser 127: inactivated YAP) antibody in the tympanic membrane (TM) under a negative pressure load and in human middle ear cholesteatoma tissues. RESULTS The number of Wnt5a-positive cells had increased and YAP nuclear translocation was observed in epithelial and mesenchymal cells in the pars flaccida (PF) of the TM under a negative-pressure load and in human middle ear cholesteatoma tissues. CONCLUSIONS We demonstrated that negative pressure in the middle ear might possibly induce cell proliferation PF of TM in response to mechanical force (mechanotransduction) through YAP nuclear translocation mediated by alternative Wnt signaling, thus affecting human middle ear cholesteatoma formation.
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Affiliation(s)
- Naotaro Akiyama
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | | | - Mamoru Yoshikawa
- Department of Otorhinolaryngology, Toho University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
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Du L, Xie YD, Liu M. [Expression and significance of PDK1 and NF-κB in the middle ear cholesteatoma]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:770-773. [PMID: 29798050 DOI: 10.13201/j.issn.1001-1781.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Indexed: 06/08/2023]
Abstract
Objective:To detect the expression of 3-phosphoinositide-dependent kinase-1(PDK1) and nuclear factor-κB(NF-κB) in human middle ear cholesteatoma tissue and to analyze their correlation.Method:Immunohistochemical method was taken to detect the expression and location of PDK1 and NF-κB in 60 cases of cholesteatoma tissue and 30 cases of normal ear skin specimens.SPSS 19.0 software was used to analyze the data. Result:Immunohistochemistry revealed PDK1 was positive in cytoplasm and the positive expression rate in cholesteatoma was significantly higher than normal skin (P <0.05); NF-κB expressed in the nucleus of cholesteatoma and the positive expression rate in cholesteatoma significantly higher than normal skin(P <0.05);In cholesteatoma specimens,there was a significant positive correlation between protein PDK1 and NF-κB(P <0.05). Conclusion:Abnormal expression of PDK1 and NF-κB may be related to the proliferation of cholesteatoma epithelium and they reinforce each other.
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Affiliation(s)
- L Du
- Department of Otology,Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Y D Xie
- Department of Otology,Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - M Liu
- Department of Otolaryngology, 463rd Hospital of Chinese PLA
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Tong J, Chen W, Deng Y, Cai X, Shan L, Du L. Surgical approaches to treating otitis media in the only hearing ear of patients with contralateral hearing loss. Int J Clin Exp Med 2015; 8:9985-9990. [PMID: 26309687 PMCID: PMC4538141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/05/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to retrospectively analyze the surgical procedures used to treat the only hearing ears of two patient cohorts diagnosed with otitis media in the last twenty years. Clinical, surgical, and follow-up data of 15 patients with otitis media in the only hearing ear who underwent middle ear surgery prior to 2000 (Cohort A) and 13 patients with a similar condition (Cohort B) who underwent middle ear surgery between 2000 and 2013 were retrospectively collected, analyzed, and compared. Mean preoperative air conduction (AC) and bone conduction of the patients in Cohort B was 61 ± 18.7 and 20 ± 15.7 dBHL, respectively. Mean preoperative and postoperative air bone gap was 43.21 ± 13.2 dBHL and 12.66 ± 3.93 dBHL, respectively. The success rate of the surgical procedures in this patient cohort was 85%. Surgery of the only hearing ear in patients with otitis media is safe and effective if performed carefully.
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Affiliation(s)
- Jun Tong
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
| | - Wenwen Chen
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
| | - Yaxin Deng
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
| | - Xunhua Cai
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
| | - Liang Shan
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
| | - Lijun Du
- Department of Otolaryngology, Branch of Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200081, China
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Karchier EB, Niemczyk K, Orłowski A. Comparison of visualization of the middle ear by microscope and endoscopes of 30° and 45° through posterior tympanotomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:276-81. [PMID: 25097700 DOI: 10.5114/wiitm.2014.41618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/05/2013] [Accepted: 05/29/2013] [Indexed: 12/29/2022] Open
Abstract
Introduction Endoscopic-assisted microsurgery of the middle ear enables the field of view of the surgeon to be expanded during the removal of inflammatory tissue from the tympanic cavity and during myringo- and ossiculoplasty. Canal wall up tympanoplasty with posterior tympanotomy is a gold standard in surgical treatment of chronic otitis media. Most applications of endoscopy in middle ear surgery concern exclusively the endoscopic transcanal approach. Aim To determine the usefulness of endoscopic visualization during the standard surgical approach through the posterior tympanotomy. Material and methods The study compared the visualization of the elements of the middle ear through the posterior tympanotomy by endoscopes with 30° and 45° optics and a microscope. Posterior tympanotomy was performed in eleven temporal bones. Visualization of the tympanic recesses was assessed on a subjective scale. A microscope and 30° and 45° endoscopes were used for inspection of the hypotympanum, sinus tympani, Eustachian tube, Prussak's space and footplate. Friedman ANOVA test and Dunn's multiple comparisons test were used for statistical analysis of the data. Results Visualization of particular recesses by endoscopes, both 30° and 45°, was excellent, while the microscopic view was statistically significantly worse, especially for sinus tympani, Prussak's space and footplate. There were no significant differences in visibility of the middle ear spaces between the two types of endoscopic optics. Conclusions Additional application of the endoscopes during middle ear surgery provides valuable information due to excellent visualization of key recesses usually hidden from the microscope.
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