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Nishiike S, Michiba T, Ito R, Ashida N, Kato H, Kuki A, Ogawa K, Tamura K, Uetsuka S. Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room. J Laryngol Otol 2024; 138:405-409. [PMID: 37646247 DOI: 10.1017/s0022215123001433] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy. METHOD In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter. RESULTS The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes. CONCLUSION Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.
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Affiliation(s)
- S Nishiike
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - T Michiba
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - R Ito
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - N Ashida
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - H Kato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Kuki
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Tamura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - S Uetsuka
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
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Ock J, Choi Y, Lee DG, Chung JW, Kim N. Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation. Sci Rep 2024; 14:7661. [PMID: 38561420 PMCID: PMC10984916 DOI: 10.1038/s41598-024-58359-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/28/2024] [Indexed: 04/04/2024] Open
Abstract
Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Yeonjoo Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Dong-Gyu Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, South Korea.
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Tawk K, Umemoto KK, Al-Seraji A, Mazhari N, Abouzari M, Djalilian HR. A Novel Technique of Reduction Meatoplasty for Correction of Very Large Meatus from a Previous Canal Wall-Down Mastoidectomy. Otol Neurotol 2024; 45:281-284. [PMID: 38238906 DOI: 10.1097/mao.0000000000004110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To evaluate the efficacy of reduction meatoplasty, a novel technique aiming to improve the usage of molded hearing aids and ear plugs in patients undergoing mastoid obliteration of a previous canal wall-down (CWD) mastoidectomy, complicated with a very large meatus. PATIENTS Twenty-six patients from a tertiary care neurotology clinic with a very large meatus from a previous CWD mastoidectomy, who were unable to use molded hearing aids or ear plugs for water protection. INTERVENTION Reduction meatoplasty after mastoid obliteration (cartilage strips and bone pate) of the CWD mastoidectomy. The procedure involves removing a wedge of skin and underlying soft tissue superiorly in the meatus. MAIN OUTCOME MEASURES Reduction in meatus size, enabling usage of hearing aids and ear plugs. RESULTS Twenty-six patients underwent mastoid obliteration and reduction meatoplasty to reduce meatus size. Patients were followed up for an average of 22 months postoperation. After operation, the meatus size was significantly reduced in all patients, enabling usage of over-the-counter ear plugs. In addition, all six patients with hearing aids could use standard occlusive hearing aid domes without requiring molded hearing aids. No patients showed symptoms of chronic infection in the mastoid cavity during the follow-up period. CONCLUSIONS Results of reduction meatoplasty showed significant improvements in functionality of the external auditory meatus, indicating that this technique is effective in reducing meatus size and improving the normal meatal anatomy after mastoid obliteration.
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Affiliation(s)
- Karen Tawk
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Kayla K Umemoto
- California Northstate University College of Medicine, Elk Grove, California
| | - Abdula Al-Seraji
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Najva Mazhari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California
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Barbara M, Margani V, Covelli E, Romano A, Bozzao A, Lotfy R, Mandour M, Swaid A, Soltan I, Elzayat S, Elfarargy HH. Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study. Otol Neurotol 2024; 45:e162-e169. [PMID: 38361294 DOI: 10.1097/mao.0000000000004116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI). STUDY DESIGN It was a prospective case-series study. SETTINGS The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023. SUBJECTS We included 73 CI candidates performed via the PT approach. INTERVENTION The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery. MAIN OUTCOME MEASURE We correlated this score with the intraoperative difficulty and surgical duration. RESULTS The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p < 0.0001). CONCLUSIONS Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.
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Affiliation(s)
- Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Valerio Margani
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs (NEMOS), Sant Andrea University Hospital, Sapienza University, Italy
| | - Andrea Romano
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Alessandro Bozzao
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rasha Lotfy
- Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mahmoud Mandour
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ali Swaid
- Otorhinolaryngology Department, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Islam Soltan
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Kafrelsheikh University, Kafrelsheikh, Egypt
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Mudry A, Plontke SK. 150 years ago: Schwartze's 1873 mastoidectomy and its implementation over the following 2 years. HNO 2024; 72:192-198. [PMID: 38289500 PMCID: PMC10879216 DOI: 10.1007/s00106-023-01418-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND In 1873, Hermann Schwartze and Adolf Eysell described a new surgical technique for treating mastoid disease using a mallet, chisels, and gouges of various sizes instead of trephines or drill instruments also called "modern mastoidectomy." On the 150th jubilee of this landmark article, we pay tribute by studying the reception and implementation of mastoidectomy in the 2 years following its publication. METHODS The commentaries published in the otological and medical literature between the second part of 1873 to the end of 1875 were studied with an emphasis on the three specialized otological journals and the otological textbooks that existed during this period. RESULTS AND CONCLUSION The princeps paper Ueber die künstliche Eröffnung des Warzenfortsatzes ("On the artificial opening of the mastoid process") by Hermann Schwartze and Adolf Eysell published in 1873 was rapidly disseminated in the medical literature for nearly 1 year, and then entered a phase of evaluation followed by a phase of extension and implementation, before finding its definitive place in the history of mastoid process surgery.
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Affiliation(s)
- Albert Mudry
- School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, USA
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Plontke SK, Mudry A. [150 years ago: the Schwartze mastoidectomy 1873]. HNO 2024; 72:190-191. [PMID: 38289499 DOI: 10.1007/s00106-023-01419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - Albert Mudry
- School of Medicine, Department of Otolaryngology, Head & Neck Surgery, Stanford University, Stanford, USA
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Demir BT, Akduman D, Bilecenoğlu B, Orhan K. Evaluation of the Sigmoid Sinus Morphology by Cone Beam Computed Tomography; Touchstone of the Posterior Cranial Fossa. World Neurosurg 2024; 183:e127-e135. [PMID: 38043743 DOI: 10.1016/j.wneu.2023.11.139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the relationship of the sigmoid sinus (SS) with the external auditory canal, facial nerve, and mastoid cells from an anatomic point of view, to define the position of the SS during transmastoid, translabyrinthine, retrosigmoid (lateral suboccipital) approaches, in tympanomastoidectomy and posterior cranial fossa surgery. METHODS In this study, the morphologic structures associated with the sigmoid sinus were evaluated in cone beam computed tomography images taken between 2015 and 2022. The images of 68 men and 106 women, aged 18-65 years, obtained from the archive of Ankara University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology were analyzed. RESULTS The most common SS pattern was type II, with a rate of 60.8% (n = 209); the second was type III, with 20.6% (n = 71); and the least common was type I, with 18.6% (n = 64). Although the distance between the horizontal line passing through the external auditory canal and facial nerve and the anterior contour of the SS was highest in type I (right, 7.26 ± 1.62; left, 7.44 ± 0.97), it was lowest in type III (right, 4.40 ± 1.50; left, 4.84 ± 1.16) (P < 0.05). CONCLUSIONS This study highlights the importance of the SS position in surgery, with special reference to otologic, neurotologic, and posterior cranial fossa surgery. To avoid intraoperative complications, each patient should be evaluated preoperatively by appropriate radiologic methods.
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Affiliation(s)
- Berin Tuğtağ Demir
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey.
| | - Davut Akduman
- Department of Otorhinolaryngology, Gulhane Faculty of Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Burak Bilecenoğlu
- Department of Anatomy, Faculty of Medicine, Ankara Medipol University, Ankara, Turkey
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Shady EFA, El-Mofty IAM, Hegazy ESA, Abdelhakam RB, Abdelsamie AM. Comparison between classic 'Fisch' and 'corner-tag' meatoplasty techniques after canal wall down tympano mastoidectomy. Am J Otolaryngol 2024; 45:104072. [PMID: 37801745 DOI: 10.1016/j.amjoto.2023.104072] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE To compare outcomes of two different methods of meatoplasty following Canal Wall-Down tympanomastoidectomy. METHODS A retrospective case review study of 48 patients with non-complicated unsafe chronic suppurative otitis media candidate for post-auricular canal wall-down tympanomastoidectomy via a post-auricular approach at Otolaryngology department, Benha university hospitals from January 2021 to January 2023, all were operated for the first time, and divided into 2 groups each of 24 patients. Group A submitted for classic 'Fisch', and group B 'Corner-Tag' meatoplasty. RESULTS The mean age was 28.88 ± 13.26 years in group A and 33.33 ± 16.04 years in group B. Only one patient (4.2 %) in each group developed wound infection and none in both groups developed perichondritis. Two patients (8.3 %) in group B compared to only one patient (4.2 %) in group A had granulations on the meatal incision. One patient (4.2 % of group A) needed revision meatoplasty. Group B needed more time for epithelization (mean 7.33 ± 0.96 weeks) than group A (mean 6.5 ± 0.88 weeks; P = 0.003*) also resulted in wider mean new meatus in group B (mean 10.50 ± 1.02 mm) than in group A (mean 9.63 ± 1.41 mm; P = 0.02*). CONCLUSION Both techniques had comparable post-operative complications. 'Corner-Tag' technique needed more time for healing and epithelization but gave a wider new meatal diameter than 'Fisch' meatoplasty after one year of follow-up.
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Affiliation(s)
- Eslam Farid Abu Shady
- Otorhinolaryngology Department, Faculty of Medicine, Benha University, Benha, Qalyubia, Egypt.
| | | | | | - Rehab Bassam Abdelhakam
- Otorhinolaryngology Department, Faculty of Medicine, Benha University, Benha, Qalyubia, Egypt
| | - Alaa Mohamed Abdelsamie
- Otorhinolaryngology Department, Faculty of Medicine, Benha University, Benha, Qalyubia, Egypt.
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Faramarzi M, Faramarzi A. In Reference to Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-analysis. Laryngoscope 2023; 133:E69. [PMID: 37572040 DOI: 10.1002/lary.30947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Illés K, Horváth T. Reply to Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:E70. [PMID: 37572048 DOI: 10.1002/lary.30946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Kata Illés
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Horváth
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Lim SJ, Jeon ET, Baek N, Chung YH, Kim SY, Song I, Rah YC, Oh KH, Choi J. Prediction of Hearing Prognosis After Intact Canal Wall Mastoidectomy With Tympanoplasty Using Artificial Intelligence. Otolaryngol Head Neck Surg 2023; 169:1597-1605. [PMID: 37538032 DOI: 10.1002/ohn.472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/02/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To evaluate the performance of a machine learning model and the effects of major prognostic factors on hearing outcomes following intact canal wall (ICW) mastoidectomy with tympanoplasty. STUDY DESIGN Retrospective cross-sectional study. SETTING Tertiary hospital. METHODS A total of 484 patients with chronic otitis media who underwent ICW tympanomastoidectomy between January 2007 and December 2020 were included in this study. Successful hearing outcomes were defined by a postoperative air-bone gap (ABG) of ≤20 dB and preoperative air conduction (AC)-postoperative AC value of ≥15 dB according to the Korean Otological Society guidelines for outcome reporting after chronic otitis media surgery. The light gradient boosting machine (LightGBM) and multilayer perceptron (MLP) models were tested as artificial intelligence models and compared using logistic regression. The main outcome assessed was the successful hearing outcome after surgery, measured using the area under the receiver operating characteristic curve (AUROC). RESULTS In the analysis using the postoperative ABG criterion, the LightGBM exhibited a significantly higher AUROC compared to those of the baseline model (mean, 0.811). According to the difference between preoperative and postoperative AC, the MLP showed a significantly higher AUROC than those of the baseline model (mean, 0.795). CONCLUSION This study analyzed multiple factors that could affect the hearing outcome using different artificial intelligence models and found that preoperative hearing status was the most important factor. Our findings provide additional information regarding postoperative hearing for clinicians.
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Affiliation(s)
- Sung Jin Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Eun-Tae Jeon
- Department of Neurology, Korea University Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Namyoung Baek
- Medical Science Research Center, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Young Han Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sang Yeop Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
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Abstract
OBJECTIVES The purpose of this study was to compare the surgical outcomes of Polycel® and titanium in ossiculoplasty following tympanomastoidectomy (TM). METHODS A total of 221 patients underwent ossiculoplasty following TM by a single surgeon using either Polycel® or titanium as prosthesis. Hearing was tested preoperatively and postoperatively at 6 months by pure-tone audiometry. Successful surgery was defined if postoperative air-bone gap (ABG) was <20 dB, the gain in air conduction (AC) hearing was >15 dB HL, or postoperative AC was <30 dB HL. Multiple linear regression was conducted to identify the factors associated with the surgical outcomes. RESULTS In canal wall up mastoidectomy (CWUM), both Polycel® and titanium showed favorable successful rates if partial ossicular replacement prosthesis (PORP) was used (64.3% of Polycel® and 67.6% in titanium). If total ossicular replacement prosthesis (TORP) was used, both represented similar outcomes (54.5% of Polycel® and 75.0% in titanium). In canal wall down mastoidectomy (CWDM), significant ABG reductions were observed only in the titanium group (5.2 ± 14.7 dB of Polycel® [P = .083] and 7.0 ± 14.2 dB of titanium [P = .002] in PORP; 4.6 ± 13.5 dB of Polycel® [P = .097] and 9.5 ± 11.2 dB of titanium [P < .001] in TORP). In multivariate analysis, titanium had a positive effect on the reduction of postoperative AC thresholds (B: -4.772; 95% CI: -8.706--0.838). CONCLUSIONS Both Polycel® and titanium showed favorable surgical outcomes for ossiculoplasty following CWUM. Titanium prosthesis is recommended for surgery after CWDM.
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Affiliation(s)
- Hantai Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Jungho Ha
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Oak-Sung Choo
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Hannah Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
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Song I, Oh KH, Kim HJ, Lee YH, Lim KH, Yoon HS, Rah YC, Choi J. Audiologic results of total ossicular replacement prosthesis bypassing the stapes suprastructure in canal wall down mastoidectomy. Am J Otolaryngol 2023; 44:103969. [PMID: 37437334 DOI: 10.1016/j.amjoto.2023.103969] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Sometimes performing PORP adequately is challenging when the stapes is tilted or the suprastructure is partially damaged owing to inflammation or infection. In such cases, the implementation of a TORP bypassing the stapes can be a useful alternative. This study aimed to investigate whether bypassing the stapes suprastructure during total ossicular replacement prosthesis (TORP) affects postoperative complications or audiological outcomes. MATERIAL AND METHODS Among 104 patients who underwent open cavity mastoidectomy and ossiculoplasty using a titanium prosthesis at Korea University Ansan Hospital between January 2012 and December 2019, we compared the preoperative and postoperative audiological results and surgical complications of 52, 21, and 31 patients who underwent partial ossicular replacement prosthesis (PORP), TORP bypassing the remaining stapes suprastructure, and TORP on the stapes footplate or oval window, respectively. RESULTS The air-bone gap before surgery was significantly different in the TORP on the stapes footplate group (34.2 ± 12.0 dB) than that in the PORP (22.9 ± 13.8 dB) and TORP bypassing the stapes groups (20.7 ± 11.5 dB, p < 0.001). After surgery, there were no significant differences among the groups (p = 0.818). The air-bone gap difference before surgery was associated with the presence of stapes before surgery (p < 0.001). There was no difference in the proportion of postoperative tympanic perforation, whether it was a revision surgery, malleus status, or the size of perforation of the tympanic membrane among the three groups. CONCLUSION When performing ossiculoplasty using TORP, bypassing the stapes did not affect surgical and audiologic outcomes.
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Affiliation(s)
- Insik Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Kyoung Ho Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hong Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ye Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Kang Hyeon Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hee Soo Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Yoon Chan Rah
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - June Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea; Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
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Solis-Pazmino P, Siepmann T, Scheffler P, Ali NES, Lincango-Naranjo E, Valdez TA, Prokop LJ, Min-Woo Illigens B, Ponce OJ, Ahmad IN. Canal wall up versus canal wall down mastoidectomy techniques in the pediatric population with cholesteatoma: A systematic review and meta-analysis of comparative studies. Int J Pediatr Otorhinolaryngol 2023; 173:111658. [PMID: 37666040 DOI: 10.1016/j.ijporl.2023.111658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 09/06/2023]
Abstract
IMPORTANCE The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of canal wall-up (CWU) versus canal wall-down (CWD) procedures. Pediatric cholesteatoma has high rates of recurrence (16%-54%). In adults, there is evidence that the selection of surgical techniques affects recurrence rates. This has not been shown in children. OBJECTIVES 1. To systematically review the literature on recurrent and residual cholesteatoma after CWU and CWD in children and perform a meta-analysis of the data. 2. To assess the rates of recurrent and residual cholesteatoma between CWU and CWD techniques in pediatric patients. 3. To assess hearing outcomes by evaluating postoperative differences in the air-bone gap (ABG) between CWU and CWD techniques. DATA SOURCES A systematic search of PubMed, Embase, Scopus, and Cochrane Collaboration was performed from inception to May 1st, 2020, to identify studies that compared CWU and CWD procedures for acquired cholesteatoma in children. STUDY SELECTION Search records were screened in duplicate by four reviewers. Inclusion criteria consisted of comparative randomized clinical trials and observational studies assessing outcomes of CWU and CWD techniques in the pediatric population. Studies involving patients with congenital cholesteatoma were excluded. DATA EXTRACTION AND SYNTHESIS Four reviewers working independently and in duplicate systematically reviewed and extracted study data. Dichotomous variables were analyzed as risk ratios (RR), while continuous variables were compared using weighted mean differences (MD). The risk of bias was assessed using the CLARITY Scale. PRIMARY OUTCOMES AND MEASURES The outcomes were recurrence, residual disease, air-bone gap (ABG), and air conductive (AC) thresholds. RESULTS After screening 1036 publications, 17 retrospective cohort studies were selected. 1333 children were included; the overall mean age was ten years (SD 7.9), and the overall mean follow-up time was 5.9 years (SD 6.6). CWU and CWD techniques were performed in 60% (796) and 40% (537) cases. We did not find differences in cholesteatoma recurrence (RR: 1.50, 95% CI 0.94; 2.40; n = 544; I2 0%; Tau [2]: 0.00), or rates of residual cholesteatoma (RR 1.51, 95% CI 0.96; 2.38, n = 506; I2: 0%; Tau [2]: 0.00) in patients who underwent CWU and CWD mastoidectomy. The mean air-bone gap was lower with CWU than CWD (mean difference: 7.60, 95% CI -10.65; -4.54; n = 242; I2: 71%; Tau [2]: 5.98). CONCLUSION and relevance: We show similar rates of recurrence and residual disease after either CWU or CWD tympanoplasty. Our results challenge the fundamental principle of CWD surgery as a standard technique, as there is no difference in rates of recurrence and residual disease in CWU and CWD. Moreover, audiometric results support CWU with improved hearing outcomes. TRIAL REGISTRATION PROSPERO identifier: CRD42020184029.
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Affiliation(s)
- Paola Solis-Pazmino
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care, Dresden International University, Dresden, Germany; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Patrick Scheffler
- Department of Otolaryngology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Noor-E-Seher Ali
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, IL, USA
| | - Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA; Division of Health Care, Dresden International University, Dresden, Germany
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA
| | - Larry J Prokop
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA
| | - Iram N Ahmad
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, CA, USA.
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15
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Jones JW, Ballard DP, Hillman TA, Chen DA. Outcomes of Mastoidectomy With Antibiotic Catheter Irrigation for Patients With Draining Ventilation Tubes. Ear Nose Throat J 2023; 102:673-679. [PMID: 34130511 DOI: 10.1177/01455613211025742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea. METHODS A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes). RESULTS There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant (P = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, P = .02) with no significant difference in word recognition scores (P = .68). Methicillin-resistant Staphylococcus aureus was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures. CONCLUSIONS Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.
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Affiliation(s)
- Joel W Jones
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Daniel P Ballard
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Todd A Hillman
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Douglas A Chen
- Pittsburgh Ear Associates, Allegheny General Hospital, Pittsburgh, PA, USA
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Wesson T, Sharma D, Rodman C, Tucker BJ, Romano DR, Chen J, Mulinaro L, Carroll AE, Illing EA, Bennett W, Burgin SJ. Evolving microbial patterns of acute mastoiditis in pediatric patients undergoing mastoidectomy. Int J Pediatr Otorhinolaryngol 2023; 172:111690. [PMID: 37544073 DOI: 10.1016/j.ijporl.2023.111690] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To investigate the microbial patterns and clinical outcomes of pediatric patients undergoing mastoidectomy for acute coalescent mastoiditis and to identify factors associated with poor outcomes and/or prolonged treatment. STUDY DESIGN Monocentric retrospective cohort study. SETTING Tertiary referral pediatric hospital in Indiana. METHODS By cross-referencing database data from the Pediatric Health Information System (PHIS) querying for all inpatient stays (patients younger than eighteen) with a diagnostic code of mastoiditis between January 1st, 2010 and August 31, 2019, and the electronic health record (Cerner) for Riley Hospital for Children, 46 patients with mastoidectomy were included. A two-tailed T-test was used to evaluate continuous parametric data. Statistical significance was determined as P < 0.05. For continuous variables, data was analyzed using continuous logistic regression. A criteria of p > 0.1 was used for inclusion in the multivariate regression. RESULTS Inclusion criteria was met by 46 patients. From 2010 to 2019, S. pyogenes and S. pneumoniae were the most common bacteria, each isolated in 11 of 42 bacterial isolates (26.2%). There was no growth in 35.4% (17/48) of intra-operative wound cultures. On univariate analysis, patients with negative cultures had longer length of hospital stay (LOS) (7.7 days [6.5] vs. 4.3 [2.8]; p = 0.018) as well as higher rates of PICC (peripherally inserted central catheter) placement (53.3% vs. 19.4%; p = 0.021). There was a statistically significant difference in terms of gender (p = 0.021), with 15 males and 16 females in the positive culture cohort and 13 males and 2 females in the negative culture cohort. On multivariate analysis, which included gender, PICC placement, both intracranial and extracranial complications, duration of antibiotics, and LOS, female gender was the only significant predictor of positive culture status (p = 0.039). CONCLUSION S. pyogenes and S. pneumoniae were the predominant etiologic agents in acute coalescent mastoiditis between 2010 and 2019, and negative wound cultures were associated with worse clinical outcomes.
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Affiliation(s)
- Troy Wesson
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dhruv Sharma
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Cole Rodman
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Brady J Tucker
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel R Romano
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jerry Chen
- Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA
| | - Lindsay Mulinaro
- Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - Aaron E Carroll
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Elisa A Illing
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA
| | - William Bennett
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Pediatrics, Indianapolis, IN, USA
| | - Sarah J Burgin
- Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Department of Otolaryngology-Head and Neck Surgery, Indianapolis, IN, USA; Eskenazi Health Ear, Nose, and Throat and Audiology, Indianapolis, IN, USA. http://sburgin.iupui.edu
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17
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Chen Y, Goodridge A, Sahu M, Kishore A, Vafaee S, Mohan H, Sapozhnikov K, Creighton FX, Taylor RH, Galaiya D. A force-sensing surgical drill for real-time force feedback in robotic mastoidectomy. Int J Comput Assist Radiol Surg 2023; 18:1167-1174. [PMID: 37171660 PMCID: PMC11060417 DOI: 10.1007/s11548-023-02873-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Robotic assistance in otologic surgery can reduce the task load of operating surgeons during the removal of bone around the critical structures in the lateral skull base. However, safe deployment into the anatomical passageways necessitates the development of advanced sensing capabilities to actively limit the interaction forces between the surgical tools and critical anatomy. METHODS We introduce a surgical drill equipped with a force sensor that is capable of measuring accurate tool-tissue interaction forces to enable force control and feedback to surgeons. The design, calibration and validation of the force-sensing surgical drill mounted on a cooperatively controlled surgical robot are described in this work. RESULTS The force measurements on the tip of the surgical drill are validated with raw-egg drilling experiments, where a force sensor mounted below the egg serves as ground truth. The average root mean square error for points and path drilling experiments is 41.7 (± 12.2) mN and 48.3 (± 13.7) mN, respectively. CONCLUSION The force-sensing prototype measures forces with sub-millinewton resolution and the results demonstrate that the calibrated force-sensing drill generates accurate force measurements with minimal error compared to the measured drill forces. The development of such sensing capabilities is crucial for the safe use of robotic systems in a clinical context.
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Affiliation(s)
- Yuxin Chen
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Anna Goodridge
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Manish Sahu
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA.
| | - Aditi Kishore
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Seena Vafaee
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Harsha Mohan
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Katherina Sapozhnikov
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
| | - Francis X Creighton
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Russell H Taylor
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deepa Galaiya
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Africa RE, Westenhaver ZK, Zimmerer RE, McKinnon BJ. Analysis of Postoperative Outcomes and Economic Behavior Trends of Tympanoplasty and Mastoidectomy With Expansion of High Deductible Health Plans. Otol Neurotol 2023; 44:e160-e165. [PMID: 36728473 DOI: 10.1097/mao.0000000000003788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
HYPOTHESIS With rising deductibles, patients will delay ear surgeries toward the end of the year, and there will be an increase in postoperative complications. BACKGROUND The Affordable Care Act (ACA), passed on March 23, 2010, expanded high deductible health plans. The deductible can provide support for patients with high medical costs, but high deductibles deter patients from seeking necessary preventive health care and having elective procedures. Patients may defer care toward the end of the year until the deductible is met. The purpose of this study is to evaluate the relationship between expanding high deductible health plans and the repeal of the ACA's individual mandate on December 22, 2017, with the economic behavior trends of tympanoplasty and mastoidectomy in the fiscal year and surgical outcomes. METHODS TriNetX was used to obtain summary statistics of patients who had tympanoplasty and/or mastoidectomy from 58 health care organizations. TriNetX is a global federated database that contains de-identified patient data from the electronic medical records of participating health care institutions. This study evaluated the trends in ear surgeries from 2005 to 2021 in the fiscal quarters 1 and 4. Relative risk of developing postoperative complications was statistically interrogated. RESULTS The average rate of ear surgeries measured in cases/year was higher in Quarter 4 than in Quarter 1 after the expansion of higher deductible health plans (180; 124; p < 0.0001). After the repeal of the ACA's individual mandate, the rate of ear surgeries in Quarter 4 significantly decreased compared to post-ACA (-3.7; 287; p = 0.0002). No statistically significant differences were notable in postoperative complications. CONCLUSIONS The expansion of high deductible health plans with a rise in deductibles is associated with an increase in ear surgeries toward the end of the year. The repeal of the ACA's individual mandate is associated with a decreased rate of ear surgeries compared to post-ACA implementation. Despite financial concern, there was no increase in postoperative complications toward the end of the year.
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Affiliation(s)
| | | | | | - Brian J McKinnon
- Department of Otolaryngology-Head and Neck Surgery University of Texas Medical Branch, Galveston, TX
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Pipaliya RM, Raymond MJ, Rowley MA, Jasper PM, Meyer TA. Video Analysis of Otologic Instrument Movement During Resident Mastoidectomies. Otol Neurotol 2022; 43:e1115-e1120. [PMID: 36351226 DOI: 10.1097/mao.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To measure surgical instrument movement during resident mastoidectomies and identify metrics that correlate with experience. STUDY DESIGN Retrospective case series. SETTING Tertiary care center. SUBJECTS Ten postgraduate year (PGY) 2, 6 PGY3, 7 PGY4, and 19 PGY5 recordings of mastoidectomy performed by otolaryngology residents. INTERVENTIONS One-minute intraoperative recordings of mastoidectomies performed during cochlear implantation were collected. Drill and suction-irrigator motion were analyzed with sports motion tracking software. MAIN OUTCOME MEASURES Mean instrument speed, angle, and angular velocity were calculated. Mann-Whitney U tests compared mean instrument metrics between PGY levels. Change in drill speed for seven residents between their PGY2 to PGY5 years was individually analyzed. RESULTS Mean drill speed was significantly greater for PGY5 residents compared with PGY2s (2.9 versus 1.8 cm/s, p = 0.001). Compared with PGY2 residents, suction speed was greater as a PGY5 (1.2 versus 0.9 cm/s; p = 0.201) and significantly greater as a PGY4 (1.5 versus 0.9 cm/s, p = 0.039). Of the seven residents individually analyzed, group mean drill speed increased by 0.4 cm/s, yearly. CONCLUSIONS Drill and suction-irrigator movement during the second minute of drilling of a cortical mastoidectomy seems to increase with resident level. Objective video analysis is a potential adjunct for differentiating novices from more experienced surgeons and monitoring surgical skills progress.
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Affiliation(s)
- Royal M Pipaliya
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
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Zagzoog N, Rastgarjazi S, Ramjist J, Lui J, Hopfgartner A, Jivraj J, Yeretsian T, Zadeh G, Lin V, Yang VXD. Pilot Study of Optical Topographic Imaging Based Neuronavigation for Mastoidectomy. World Neurosurg 2022; 166:e790-e798. [PMID: 35953033 DOI: 10.1016/j.wneu.2022.07.150] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a novel registration technique that allows rapid registration with minimal navigational error. To date, no studies have examined the use of OTI in skull-base procedures. METHODS In this cadaveric study, 8 mastoidectomies were performed in 2 groups-4 free-hand (FH) and 4 OTI-assisted mastoidectomies. Registration accuracy for OTI navigation was quantified with root mean square (RMS) and target registration error (TRE). Procedural time, percent of mastoid resected, and the proximity of the mastoidectomy cavity to critical structures were determined. RESULTS The average RMS and TRE associated with OTI-based registration were 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. The volume removed, expressed as a percentage of the total mastoid volume, was 37.5% (±10.2%) versus 31.2% (±2.3%), P = 0.31, for FH and OTI-assisted mastoidectomy. There were no statistically significant differences between FH and OTI-assisted mastoidectomies with respect to proximity to critical structures or procedural time. CONCLUSIONS This work is the first examining the application of OTI neuronavigation in lateral skull-base procedures. This pilot study revealed the RMS and TRE for OTI-based navigation in the lateral skull base are 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. This pilot study demonstrates that an OTI-based system is sufficiently accurate and may address barriers to widespread adoption of navigation for lateral skull-base procedures.
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Affiliation(s)
- Nirmeen Zagzoog
- Institute of Medical Science, School of Graduate Studies, Faculty of Medicine, Toronto, Ontario, Canada; Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada.
| | - Siavash Rastgarjazi
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Joel Ramjist
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Justin Lui
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Otolaryngology, Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Adam Hopfgartner
- Orthopedic Biomechanics Laboratory, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jamil Jivraj
- Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada
| | - Tiffany Yeretsian
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victor X D Yang
- Brain Sciences Program/Imaging Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Bioengineering and Biophotonics Laboratory, Ryerson University, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Wang Y, Wang CH, Chen HC. Inflammatory Pseudotumour of Temporal Bone in a Multiple-Comorbidity Patient. J Coll Physicians Surg Pak 2022; 32:S168-S170. [PMID: 36210684 DOI: 10.29271/jcpsp.2022.supp2.s168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/14/2020] [Indexed: 06/16/2023]
Abstract
Inflammatory pseudotumour (IPT) of the temporal bone is relatively rare in the head and neck, but it is important for clinicians to be aware of this emerging entity. A 39-year man presented with a protruding reddish mass over the left external ear. High-resolution Computed Tomography and Magnetic Resonance Imaging of temporal bone showed soft tissue collection in the left external ear, middle ear, and mastoid cavity with bony erosion. The patient first received modified radical mastoidectomy. Several surgeries were required for recurrences with eventual intracranial invasion within 2 years. The pathology showed chronic inflammation without malignancy, autoimmune or infectious pathologies. Based on the clinical manifestations, IPT was diagnosed. Finally, radiation therapy (RT) with 30 Gy was given. There was no recurrence following the RT course. Early recognition of IPT presenting as a recurrent and locally aggressive inflammatory lesion in the temporal bone is necessary to achieve favorable outcomes. Key Words: Inflammatory pseudotumour, Temporal bone, Radiation therapy.
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Affiliation(s)
- Yao Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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高 竞, 刘 卓, 阮 标, 李 书, 江 超, 杨 晶, 陆 涛, 龙 瑞. [Evaluation of cross-sectional area and morphological value of external auditory meatus in concha plasty with I shaped incision]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2022; 36:289-292. [PMID: 35511622 PMCID: PMC10128188 DOI: 10.13201/j.issn.2096-7993.2022.04.010] [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: 12/06/2021] [Indexed: 06/14/2023]
Abstract
Objective:To evaluate the preliminary value of the cross-sectional area and morphological changes of the external ear canal opening after the two-flap auriculoplasty through the I shaped posterior incision. Methods:One hundred and thirty-seven patients(a total of 155 ears) who received open radical mastoidectomy in the department of otolaryngology in the First Affiliated Hospital of Kunming Medical University were treated with I shaped incision and two-flap auriculoplasty. Vertical diameter(D1) and horizontal diameter(D2) of the external ear canal were measured at the completion of surgery, 1 month and 6 months post-operation, respectively. The cross-sectional area(S=1/4πD1×D2) of the external ear canal was calculated according to the two diameters. The dry ear time and intraoperative lumen epithelialization time were observed after operation. At 6 months after operation, the morphology of the external ear canal opening was analyzed. Results:The postoperative dry ear duration was 18-61 days(27.32±7.52) days. The time to complete epithelialization of the operative cavity was 24-70 days(32.18±10.36) days. Six months after the operation, the morphological classification of 155 outer ear meatal openings was as follows: 117 ears( 75.48%) were round(the difference between vertical diameter and horizontal diameter was within 2 mm); Oval(oval appearance, difference between vertical diameter and horizontal diameter greater than 2 mm) 35 ears(22.58%), triangle 3 ears(1.94%); Irregular ear canal orifice was not observed in all cases. During the operation, and at 1 month and 6 months after the operation, the cross-sectional area of the external ear canal was(2.51±0.48) cm², (2.45±0.35) cm², (2.41±0.43) cm², respectively. And no significant differences were observed. (P>0.05). Conclusion:The I shaped posterior auricular incision and two-flap auricular lumenoplasty is not compex and easy to perform. The morphology of the external ear opening is regular after the operation, which can effectively match the ventilation of the operative cavity.
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Affiliation(s)
- 竞逾 高
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 卓慧 刘
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 标 阮
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 书聆 李
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 超武 江
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 晶 杨
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 涛 陆
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - 瑞清 龙
- 昆明医科大学第一附属医院耳鼻咽喉科(昆明, 650032)Department of the Otolaryngology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
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Peñaranda A, Peñaranda D, Pérez-Herrera LC, Jiménez-Hakim E. Recurrent Primary Inverted Papilloma of the Mastoid with Intracranial Invasion: A 7-Year Follow-Up. J Int Adv Otol 2022; 18:79-83. [PMID: 35193851 PMCID: PMC9449997 DOI: 10.5152/iao.2022.20055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 55-year-old man presented to the otolaryngology department complaining of aural fullness in his left ear after an episode of probable otitis 3 months before. magnetic resonance imaging revealed a soft tissue mass within the mastoid cavity that had destroyed the posterior wall of the middle ear with no apparent middle ear or sinonasal origin. The patient underwent a left canal wall-up tympanomastoidectomy, and the pathology report confirmed an inverted papilloma. Inverted papillomas are uncommon benign epithelial tumors related to a high recurrence rate and high risk of secondary malignant transformation after multiple surgeries. The patient has undergone 2 additional surgical interventions involving the neurosurgery team due to recurrent inverted papilloma that exerted a mass effect over the left cerebellar hemisphere. Despite no signs of recurrence on magnetic resonance imaging 5 years after the last surgery, at least 1 radiologic study per year is granted. Clinical multidisciplinary follow-up including nasal endoscopy and head and neck examination as a part of a stringent follow-up is essential to rule out synchronous nasosinusal inverted papillomas.
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Affiliation(s)
- Augusto Peñaranda
- Department of Otolaryngology, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
- School of medicine, Universidad de Los Andes, Bogotá, Colombia
- Corresponding author: Augusto Peñaranda, e-mail:
| | - Daniel Peñaranda
- Otorlaryngology Section, Fundación Universitaria Ciencias de la Salud, Bogotá, Colombia
- Corresponding author: Augusto Peñaranda, e-mail:
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Eswaran S, Kumar S, Saravanam PK. Cholesteatoma extending into the sternocleidomastoid muscle presenting as a Bezold abscess. BMJ Case Rep 2021; 14:e241160. [PMID: 34844957 PMCID: PMC8634368 DOI: 10.1136/bcr-2020-241160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/04/2022] Open
Abstract
Cholesteatoma is a non-neoplastic cystic lesion arising in the middle ear cleft with the propensity to spread and recur after surgery, but it is unusual to find cholesteatoma invading sternocleidomastoid muscle after 15 years of modified radical mastoidectomy and presenting as Bezold abscess. In this report, the authors highlight the fact that cholesteatoma recurrence if neglected can present as a Bezold abscess with the invasion of cholesteatoma from the mastoid tip into the sternocleidomastoid muscle. This requires complete excision of the cholesteatoma sac along with the surrounding soft tissue.
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Affiliation(s)
- Sudhagar Eswaran
- ENT, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sarath Kumar
- ENT, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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25
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Choi J, Cho S, Chung JW, Kim N. Video recognition of simple mastoidectomy using convolutional neural networks: Detection and segmentation of surgical tools and anatomical regions. Comput Methods Programs Biomed 2021; 208:106251. [PMID: 34271262 DOI: 10.1016/j.cmpb.2021.106251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
A simple mastoidectomy is used to remove inflammation of the mastoid cavity and to create a route to the skull base and middle ear. However, due to the complexity and difficulty of the simple mastoidectomy, implementing robot vision for assisted surgery is a challenge. To overcome this issue using a convolutional neural network architecture in a surgical environment, each surgical instrument and anatomical region must be distinguishable in real time. To meet this condition, we used the latest instance segmentation architecture, YOLACT. In this study, a data set comprising 5,319 extracted frames from 70 simple mastoidectomy surgery videos were used. Six surgical tools and five anatomic regions were identified for the training. The YOLACT-based model in the surgical environment was trained and evaluated for real-time object detection and semantic segmentation. Detection accuracies of surgical tools and anatomic regions were 91.2% and 56.5% in mean average precision, respectively. Additionally, the dice similarity coefficient metric for segmentation of the five anatomic regions was 48.2%. The mean frames per second of this model was 32.3, which is sufficient for real-time robotic applications.
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Affiliation(s)
- Joonmyeong Choi
- University of Ulsan College of Medicine, Convergence Medicine, 388-1 pungnap2-dong, Radiology, East bld 2nd fl Seoul, Songpa-gu, 05505 Korea
| | - Sungman Cho
- University of Ulsan College of Medicine, Convergence Medicine, 388-1 pungnap2-dong, Radiology, East bld 2nd fl Seoul, Songpa-gu, 05505 Korea
| | - Jong Woo Chung
- University of Ulsan College of Medicine, Convergence Medicine, 388-1 pungnap2-dong, Radiology, East bld 2nd fl Seoul, Songpa-gu, 05505 Korea.
| | - Namkug Kim
- University of Ulsan College of Medicine, Convergence Medicine, 388-1 pungnap2-dong, Radiology, East bld 2nd fl Seoul, Songpa-gu, 05505 Korea.
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Tengku Kamalden TMI, Misron K. Endoscopic ear surgery during COVID-19 pandemic. Med J Malaysia 2021; 76:42-44. [PMID: 34558558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Similar to other surgical fraternities, endoscopic ear surgery (EES) faced great challenges during the COVID-19 pandemic. Many elective operations involving EES needed to be postponed, resulting in accumulated cases. Throughout one year during COVID-19, Hospital Sultan Ismail, Johor, Malaysia continued to perform various EES procedures. Although EES is an aerosol-generating procedure, it has become evidence that this minimallyinvasive surgical approach offers lesser bony drilling and shorter operative time as compared to open mastoidectomy. Thus, this reduced the risk of viral transmission to the surgeons and operating staffs.
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Affiliation(s)
- T M I Tengku Kamalden
- Hospital Sultan Ismail, Department of Otorhinolaryngology - Head and Neck Surgery, Jalan Mutiara Emas Utama, Taman Mount Austin Johor Bahru, Johor, Malaysia
| | - K Misron
- Hospital Sultan Ismail, Department of Otorhinolaryngology - Head and Neck Surgery, Jalan Mutiara Emas Utama, Taman Mount Austin Johor Bahru, Johor, Malaysia.
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27
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Luntz M, Barzilai R. [MIDDLE EAR CHOLESTEATOMA]. Harefuah 2021; 160:316-322. [PMID: 34028225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Cholesteatoma is the most severe middle ear disease. In most cases cholesteatoma results from under-aeration of the middle ear cleft. It is characterized by otorrhea and hearing loss, and may lead to severe complications, intra- and extra-cranial. There is no non-surgical treatment for cholesteatoma. Surgical treatment is the only option. Cholesteatoma is diagnosed by micro-otoscopy. When cholesteatoma is suspected and otoscopy is inconclusive, imaging is mandatory. The goal of treatment in cholesteatoma is to achieve a stable and safe ear. In most cases, upon diagnosis, cholesteatoma is quite extensive and mastoidectomy is needed. Choice of surgery [Canal wall up mastoidectomy with tympanoplasty (the more conservative alternative), Canal wall down (radical) mastoidectomy with meatoplasty or Canal wall down (radical) mastoidectomy with reconstruction of external ear canal, tympanoplasty and mastoid obliteration], depends on the extent of the disease, the anatomic relationship between the sensitive structures that protrude into the walls of middle ear and mastoid cavities and the bony destruction that had already been caused by the disease. Hearing rehabilitation should lead to a stable, predictable, symmetric and as close as possible to normal hearing threshold. In many cases the solution is external or implantable hearing devices. Cholesteatoma has a high recidivism rate that leads to repeated surgery. In order to diagnose and treat cholesteatoma recidivism, a structured follow-up is needed after cholesteatoma surgery, with periodical otoscopy (every 6-12 months) and MRI (every 1-2 years). When cholesteatoma recidivism is diagnosed, surgery is indicated before the disease grows and becomes infected.
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Affiliation(s)
- Michal Luntz
- The Ear and Hearing Center, A.R.M.-Advanced Otolaryngology Head and Neck and Maxillofacial Surgery, Assuta Medical Center, Tel Aviv, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Roni Barzilai
- The Ear and Hearing Center, A.R.M.-Advanced Otolaryngology Head and Neck and Maxillofacial Surgery, Assuta Medical Center, Tel Aviv, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
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28
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Merven M, Loock JW. THE ARTICLE "DEMONSTRATION AND MITIGATION OF AEROSOL AND PARTICLE DISPERSION DURING MASTOIDECTOMY RELEVANT TO THE COVID-19 ERA" BY CHEN JX, ET AL. [EPUB AHEAD OF PRINT] REFERS. Otol Neurotol 2021; 42:346-347. [PMID: 33122505 DOI: 10.1097/mao.0000000000002905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marc Merven
- Division of ENT Surgery (Otorhinolaryngology), Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
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Abstract
OBJECTIVE PubMed is the world's largest online collection of biomedical literature citations. A PubMed search (October 11, 2019) using the medical subject heading terms "history" and "mastoidectomy" was conducted. The heading "best matches" listed as first article "A brief history of mastoidectomy," a very relevant free full text. The aim of this study is to validate or not the relevance attributed to this study as the first article listed in best matches. METHODOLOGY All the references of the article mentioned before 1860 were checked, further completed with other original sources, and studied again, with particular attention to their extracted quotes. RESULTS Surprisingly, this article contains many inaccuracies, notably concerning Galen, Lucas van Leyden, Paré, Riolan the Younger, Justus von Berger, Jasser, Dezeimeris, Wilde and Toynbee. This was most certainly related to blind trust of some secondary references. CONCLUSION Never trust secondary references. This article also raises questions on the validity and the relevance of the best matches algorithm in PubMed.
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Affiliation(s)
- Albert Mudry
- Department of Otolaryngology, Head & Neck Surgery, Stanford University School of Medicine, Stanford, California
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30
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Baba A, Kurihara S, Fukuda T, Yamauchi H, Matsushima S, Ikeda K, Kurokawa R, Ota Y, Takahashi M, Sakurai Y, Motegi M, Komori M, Yamamoto K, Yamamoto Y, Kojima H, Ojiri H. Non-echoplanar diffusion weighed imaging and T1-weighted imaging for cholesteatoma mastoid extension. Auris Nasus Larynx 2021; 48:846-851. [PMID: 33461853 DOI: 10.1016/j.anl.2021.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES A broad mastoid extension limits cholesteatoma resection via a transmeatal approach including endoscopic ear surgery. Therefore, a preoperative diagnosis of mastoid extension is a the most critical factor to determine whether to perform mastoidectomy. The purpose of this study was to assess the efficacy of non-echoplanar diffusion-weighted imaging (non-EPI DWI) and T1-weighted imaging in the evaluation of mastoid extension in cholesteatomas of the middle ear. METHODS Patients who underwent magnetic resonance imaging (MRI) for pretreatment evaluation before primary surgery for pars flaccida or tensa cholesteatoma, which revealed a high-signal intensity in the mastoid on T2-weighed imaging were retrospectively evaluated. Two board-certified radiologists retrospectively evaluated the extent of cholesteatomas on MRI with non-EPI DWI, non-EPI DWI- and T1-weighted axial imaging. The presence of a high signal intensity on non-EPI DWI or low or high signal intensity on T1-weighted imaging in the mastoid was evaluated. All cases were subclassified as M+ (surgically mastoid extension-positive) or M- (surgically mastoid extension-negative). RESULTS A total of 59 patients with middle ear cholesteatoma were evaluated. There were 37 M+ cases and 22 M- cases. High-signal intensity on non-EPI DWI exhibited a sensitivity of 0.89 and specificity of 0.82, whereas partial low-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.84 and specificity of 0.91 for detecting mastoid involvement. Complete high-signal intensity on T1-weighted imaging exhibited a sensitivity of 0.73 and specificity of 0.89 for detecting non-involvement of the mastoid. The sensitivity (0.92) and specificity (0.96) of combined non-EPI DWI and T1-weighted imaging evaluation were higher than those of with non-EPI DWI or T1-weighted imaging alone. The interobserver agreement for the presence of high-signal intensity in the mastoid cavity on non-EPI DWI was very good at 0.82, that of a partial low-signal intensity area in the mastoid cavity lesions on T1-weighted imaging was good, at 0.76 and that of complete high-signal intensity in the mastoid cavity lesions on T1-weighted imaging was good, at 0.67. CONCLUSIONS The signal intensity on non-EPI DWI and T1-weighted imaging of the mastoid could be used to accurately assess the extent of middle ear cholesteatoma, which could facilitate surgical treatment planning.
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Affiliation(s)
- Akira Baba
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hideomi Yamauchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Satoshi Matsushima
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Koshi Ikeda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiaki Ota
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109, USA
| | - Masahiro Takahashi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yuika Sakurai
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Masaomi Motegi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Manabu Komori
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Kazuhisa Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Yutaka Yamamoto
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Hong CX, Razuan NA, Alias A, Hassan FH, Nasseri Z. Zygomatic root abscess: A rare entity not to be forgotten! Auris Nasus Larynx 2020; 48:788-792. [PMID: 32513602 DOI: 10.1016/j.anl.2020.05.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
Zygomatic root abscess is a rare extracranial extratemporal complication of otitis media. To the best of our knowledge, there are only a few scattered cases of zygomatic root abscesses reported in the literature. We present an unusual case of a zygomatic root abscess in a 24 years old adult. He presented with one month duration of right zygomatic swelling. Otoscopic examination revealed superior and posterior external auditory canal wall sagging with an intact tympanic membrane. High Resolution Computed Tomography (HRCT) temporal bone revealed a rim enhancing lesion lateral to the zygomatic process with fluid filled mastoid air cells. He was managed with antibiotics and staged surgical interventions. He recovered well. Our case serves to shed light on the pathways of infection, clinical manifestations and timely staged surgical intervention in this rare pathology.
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Affiliation(s)
- Chow Xiao Hong
- Department of Otorhinolaryngology, The National University of Malaysia, Malaysia; Department of Otorhinolaryngology, Hospital Kuala Lumpur, Malaysia
| | - Nur Aida Razuan
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Malaysia
| | - Azila Alias
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Malaysia
| | | | - Zara Nasseri
- Department of Otorhinolaryngology, The National University of Malaysia, Malaysia.
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Frithioff A, Frendø M, Mikkelsen PT, Sørensen MS, Andersen SAW. Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial. Eur Arch Otorhinolaryngol 2020; 277:1335-1341. [PMID: 32067096 DOI: 10.1007/s00405-020-05858-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL). METHODS In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation. Performances were assessed by two blinded raters using an established assessment tool. In addition, CL was estimated as the relative change in secondary-task reaction time during simulation when compared with individual baseline measurements. Data were analyzed using linear mixed model analysis for repeated measurements. RESULTS The mean final-product performance score was significantly lower in UHF VR simulation compared to cVR simulation [mean difference 1.0 points out of 17 points, 95% CI (0.2-1.7), p = 0.02]. The most important factor for performance during UHF simulation was the ability to achieve stereovision (mean difference = 3.4 points, p < 0.001). Under the UHF VR condition, CL was significantly higher than during cVR (28% vs. 18%, respectively, p < 0.001). CONCLUSION UHF graphics in VR simulation training reduced performance and induced a higher CL in novices than conventional, screen-based VR simulation training. Consequently, UHF VR simulation training should be preceded by cVR training and might be better suited for the training of intermediates or experienced surgeons.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark.
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark
| | | | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark
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CEBECİ S, ÖZBİLEN MS, BAYRAMOĞLU İ, KEMALOĞLU YK, UYGUR KK, BAYAZIT YA, KARAMERT R. Impact of the demographic and aetiological factors and intraoperative findings on postoperative outcomes in chronic otitis media surgery. Turk J Med Sci 2020; 50:155-162. [PMID: 31800200 PMCID: PMC7080348 DOI: 10.3906/sag-1907-125] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/04/2019] [Indexed: 11/03/2022] Open
Abstract
Background/aim Surgical success is related with many factors belonging to both the patient and the disease. This study aims to analyse the preoperative and intraoperative characteristics, the postoperative results, and the factors affecting the surgical success in different types of chronic otitis media (COM). Materials and methods A total of 1510 ears of 1398 patients who underwent COM surgery were included in the study. Postoperative results were obtained from 376 ears of 356 patients who had been followed after surgery. The demographic characteristics of the patients, such as age and sex, operative findings, preoperative audiological examination results, and final audiometric and otoscopic examination findings, were retrospectively obtained from the archives of the department. Results The most frequent diagnosis was simple COM (39.9%), and the most frequently performed surgery was tympanoplasty without mastoidectomy (46.6%). The overall hearing success rate was found to be 75.8%. Postoperative hearing success was significantly associated with the chronic otitis subgroup, ossicular pathologies, and the condition of the middle ear mucosa. Postoperative graft take rate was found to be 78.6%. Graft success was statistically significantly higher in patients with normal middle ear mucosa. Performing mastoidectomy, the presence of patency in aditus ad antrum, and being a paediatric case had no impact on graft success. Conclusion Factors affecting the success of COM surgery include age, chronic otitis subgroup, location and size of perforation, the condition of the middle ear mucosa, and the level of the ossicular disease. These factors should be known and an appropriate treatment plan should be prepared.
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Affiliation(s)
- Süleyman CEBECİ
- Department of ENT, Faculty of Medicine, Gazi University, AnkaraTurkey
| | | | - İsmet BAYRAMOĞLU
- Department of ENT, Faculty of Medicine, Gazi University, AnkaraTurkey
| | | | - Kadir Kemal UYGUR
- Department of ENT, Faculty of Medicine, Gazi University, AnkaraTurkey
| | | | - Recep KARAMERT
- Department of ENT, Faculty of Medicine, Gazi University, AnkaraTurkey
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Abstract
RATIONALE Facial nerve schwannoma (FNS) is a rare slow-growing nerve sheath tumor derived from Schwann cells. FNS with normal facial nerve function may sometimes be misdiagnosed as otitis media because of similar ontological symptoms such as purulence, tympanic membrane damage, and hearing loss. PATIENT CONCERNS A 68-year-old woman was referred to our department because of otorrhea and hearing loss in the right ear for 20 years. Otoscopy revealed abundant purulent secretions deep in the right external auditory canal, and granulation proliferation in the posterior part of membranae tensa. Audiogram showed a right mixed hearing loss with an 85-dB pure-tone average and 35-dB air-bone gap. DIAGNOSIS This patient was misdiagnosed as chronic suppurative otitis media before surgery. During surgery, a mass was found, and intraoperative frozen section histopathology confirmed an FNS. INTERVENTIONS This patient was subjected to mastoidectomy for curing chronic suppurative otitis media initially. During surgery, a mass was found attached and widely extended into the tympanic and mastoid segments. We removed most part of the mass, however found the mass deriving from the vertical part of the facial nerve. Intraoperative frozen section histopathology confirmed an FNS. So we removed the incurs and malleus, and searched for the edge of the mass. The mass involved multisegments of facial nerve including the tympanic, vertical and pyramidal segments. The tumor was removed completely, and nerves were repaired using greater auricular nerves. OUTCOMES After surgery, the patient had facial nerve paralysis of House-Brackmann (HB) Grade VI. Facial function recovered to HB Grade III at 30 months after surgery. The patient was followed up for 5 years. She had a facial function of HB grade III at the most recent follow-up. LESSONS FNS is rare and tend to be misdiagnosed. It is important to combine the imaging modalities of computed tomography and magnetic resonance imaging to evaluate FNS before surgery. The primary goal of managing FNS is to maintain normal facial function as long as possible; therefore, tailored strategy should be taken for managing FNS.
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Freire GSM, Sampaio ALL, Lopes RAF, Nakanishi M, de Oliveira CACP. Does ear endoscopy provide advantages in the outpatient management of open mastoidectomy cavities? PLoS One 2018; 13:e0191712. [PMID: 29370257 PMCID: PMC5784996 DOI: 10.1371/journal.pone.0191712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/27/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the use of ear endoscopy in the postoperative management of open mastoidectomy cavities, and to test whether ear endoscopy improves inspection and cleaning compared with ear microscopy. Methods Prospective study. Thirty-two ears were divided into two groups: group 1, examination and cleaning of mastoid cavities under endoscopic visualization after microscopic standard ear cleaning; group 2, examination and cleaning of mastoid cavities under microscopic visualization after endoscope-assisted ear cleaning. We assessed the ability of each method to provide exposure and facilitate cleaning, comparing the benefits of microscopy and endoscopy when used sequentially and vice-versa. Results Endoscopy provided additional benefits for exposure in 61.1% of cases and cleaning in 66.7%. Microscopy provided no additional benefits in terms of exposure in any case, and provided added benefit for cleaning in only 21.4% of cases. Discussion For outpatient postoperative care of open mastoidectomy cavities, ear endoscopy provides greater benefit over ear microscopy than vice-versa. In over half of all cases, endoscopy was able to expose areas not visualized under the microscope. Furthermore, in two-thirds of cases, endoscopy enabled removal of material that could not be cleared under microscopy. Ear endoscopy was superior to microscopy in terms of enabling exposure and cleaning of hard-to-reach sites, due to its wider field of vision. Conclusion Ear endoscopy is a feasible technique for the postoperative management of open mastoidectomy cavities. Ear endoscopy provided superior advantages in terms of exposure and aural cleaning compared with microscopy.
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Affiliation(s)
| | | | | | - Márcio Nakanishi
- Department of Otolaryngology, Hospital Universitário de Brasília (HUB), Brasília, DF, Brazil
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Flyger TF, Wanscher JH, Nguyen N, Bay M. [Meningitis and septic sinus thrombosis in connection with otitis media]. Ugeskr Laeger 2018; 180:V05170407. [PMID: 29368687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This is a case report of a 30-year-old female, who presented to the emergency department with headache, nausea and neck pain after five days of otitis media. After lumbar puncture, CT and MRI the patient was treated for meningitis with initial improvement in the clinical state. After four days she developed contralateral neurological symptoms, and after five days she had a seizure. MR-venography showed thrombosis of the lateral dural sinus with venous cerebral infarction. The treatment of intravenously administered antibiotics, mastoidectomy and anticoagulation is discussed and compared with other cases in the literature.
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Bozan N, Duzenli U, Kundi P, Turan M, Kiroglu AF. Meatal obstruction following canal wall down mastoidectomy. J PAK MED ASSOC 2017; 67:1450-1451. [PMID: 28924294] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic otitis media (COM) is completely treated with a single procedure in most patients but may require multiple surgeries in some cases. The main goals of open cavity mastoidectomy are to completely eradicate the disease, create a large enough meatus for examination and mastoid air cells, and provide a self-cleaning epithelized dry cavity, and achieve maximum hearing. In this report, we present a very rare case of COM who underwent revision mastoidectomy in our clinic due to meatal obstruction in the right ear, total sensorineural hearing loss, and pain and tenderness in the postauricular region.
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Affiliation(s)
- Nazim Bozan
- Department of Otorhinolaryngology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey.
| | | | - Pinar Kundi
- Department of Otorhinolaryngology, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Mahfuz Turan
- Department of Otorhinolaryngology, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Ahmet Faruk Kiroglu
- Department of Otorhinolaryngology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
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Sakthivel P, Yogal R, Sikka K, Thakar A, Rajeshwari M. Mastoid Osteoma - Is "Trauma" A Possible Etiologic Factor. JNMA J Nepal Med Assoc 2017; 56:367-370. [PMID: 29255322] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
A 19 year old female presented with painful postaural swelling of three years duration with preceding history of trauma. Clinically and radilogically the diagnosis of mastoid osteoma was made. As patient was symptomatic the osteoma was removed and cortical mastoidectomy was done. We emphasise that symptomatic mastoid osteomas must be treated early even if they are small in size to prevent the development of giant osteomas. The case is reported for its rarity with relevant review of literature. To the best of our knowledge this is the first case report in which there is a definitive history of trauma preceding the development of osteoma suggesting its possible role as an inciting factor.
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Affiliation(s)
- Pirabu Sakthivel
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Rijendra Yogal
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Madhu Rajeshwari
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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Hunter JB, Haynes DS, Fernando SJ, Bennett ML, Wanna GB. Response to Cochlear Implants in Canal Wall-Down Mastoidectomies. Otolaryngol Head Neck Surg 2017; 156:583-584. [PMID: 28248605 DOI: 10.1177/0194599816686945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Linder TE. Cochlear Implants in Canal Wall-Down Mastoidectomies. Otolaryngol Head Neck Surg 2017; 156:583. [PMID: 28248606 DOI: 10.1177/0194599816686944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stephen S, Subashini B, Thomas R, Philip A, Sundaresan R. Skull Base Osteomyelitis Caused by an Elegant Fungus. J Assoc Physicians India 2016; 64:70-71. [PMID: 27730788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Malignant otitIs externa (skull base osteomyelitis) is predominantly caused by bacteria while fungal etiology is rare. We report a middle aged diabetic gentleman who succumbed to invasive skull base infection due to Apophysomyces elegans a fungus belonging to Zygomycetes which causes only skin and soft tissue infections. Mortality and invasive infections due to this genus is rarely reported, especially in the ear.
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Affiliation(s)
| | - Beula Subashini
- Assistant Professor, Dept. of Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu
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