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Jeong J, Youk TM, Choi HS. Risk factors for middle ear cholesteatoma surgery based on Korean population data. Acta Otolaryngol 2024:1-6. [PMID: 38753949 DOI: 10.1080/00016489.2024.2344818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Studies of risk factors for middle ear cholesteatoma surgery using population-based data are lacking. OBJECTIVES To investigate the risk factors for cholesteatoma surgery in adults based on population data from Korea. MATERIALS AND METHODS For this retrospective study, we used Korean National Health Insurance Service National Sample Cohort data. Patients who were 20 years or older and underwent mastoidectomy from 2006 through 2015 under the diagnostic codes of cholesteatoma were defined as patients with middle ear cholesteatoma surgery. The control group was comprised of the remaining database sample in 2006. Sociodemographic factors in 2006 and histories of medical diseases, allergic diseases, and chronic sinusitis from 2003 through 2005 were compared between cholesteatoma surgery and control groups. RESULTS A total of 459 patients underwent cholesteatoma surgery. In multivariate Cox regression analysis, age 40-59 years and residence in metropolitan cities and small- and medium-sized cities and counties were significant risk factors for cholesteatoma surgery whereas allergic rhinitis, asthma, atopic dermatitis, and chronic sinusitis were not significant risk factors for middle ear cholesteatoma surgery. CONCLUSIONS AND SIGNIFICANCE The present study found no evidence of associations between allergic diseases or chronic sinusitis and cholesteatoma surgery in adults.
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Affiliation(s)
- Junhui Jeong
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae Mi Youk
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Seung Choi
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Alshehri S, Al Shalwan MAM, Oraydan AAA, Almuaddi ASH, Alghanim AJA. Factors Influencing Treatment Success in Cholesteatoma Management: A Cross-Sectional Study. J Clin Med 2024; 13:2606. [PMID: 38731136 PMCID: PMC11084144 DOI: 10.3390/jcm13092606] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Cholesteatoma presents significant management challenges in otolaryngology. This study aimed to delineate the influence of demographic and clinical characteristics, preoperative imaging, and surgical approaches on treatment success in cholesteatoma management. Methods: A cross-sectional analytical study was conducted at the Otolaryngology Department of the University Hospital from January 2021 to December 2022. It included 68 patients diagnosed with cholesteatoma, focusing on three objectives: assessing the impact of demographic and clinical characteristics on treatment outcomes, evaluating the predictive value of preoperative imaging findings, and analyzing the influence of surgical factors. Results: The study population predominantly consisted of male (56%) and Saudi (81%) patients, with an average age of 45 years. Logistic regression revealed that older age (OR: 1.05), male gender (OR: 0.63), and non-Saudi Arab ethnicity (OR: 2.14) significantly impacted treatment outcomes. Clinical characteristics such as severe disease severity (OR: 3.00) and longer symptom duration (OR: 0.96) also influenced treatment success. In preoperative imaging, labyrinthine fistula (Regression Coefficient: 0.63) and epidural extension (Coefficient: 0.55) emerged as key predictors. The surgical factors that significantly affected the outcomes included the extent of surgery (Complete Removal OR: 3.32) and the use of endoscopic approaches (OR: 1.42). Conclusions: This study highlights that patient demographics, clinical profiles, specific preoperative imaging features, and surgical strategies multifactorially determine cholesteatoma treatment success. These findings suggest the necessity for a tailored approach in cholesteatoma management, reinforcing the importance of individualized treatment plans based on comprehensive preoperative assessments.
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Affiliation(s)
- Sarah Alshehri
- Otology and Neurotology, Department of Surgery, College of Medicine, King Khalid University, Abha 61423, Saudi Arabia
| | | | | | - Abdulrahman Saeed H. Almuaddi
- College of Medicine, King Khalid University, Abha 61423, Saudi Arabia; (M.A.M.A.S.); (A.A.A.O.); (A.S.H.A.); (A.J.A.A.)
| | - Ahmed Jubran A. Alghanim
- College of Medicine, King Khalid University, Abha 61423, Saudi Arabia; (M.A.M.A.S.); (A.A.A.O.); (A.S.H.A.); (A.J.A.A.)
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Díaz Zufiaurre N, Calvo-Imirizaldu M, Lorente-Piera J, Domínguez-Echávarri P, Fontova Porta P, Manrique M, Manrique-Huarte R. Toward Improved Detection of Cholesteatoma Recidivism: Exploring the Role of Non-EPI-DWI MRI. J Clin Med 2024; 13:2587. [PMID: 38731116 PMCID: PMC11084557 DOI: 10.3390/jcm13092587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Cholesteatoma is a lesion capable of destroying surrounding tissues, which may result in significant complications. Surgical resection is the only effective treatment; however, the presence of cholesteatoma recidivism is common. This study evaluated the effectiveness of the Attic Exposure-Antrum Exclusion (AE-AE) surgical technique in treating cholesteatomas and identifying factors associated with recidivism. Additionally, the study aimed to assess the utility of non-echo-planar diffusion MRI (non-EPI-DWI MRI) in detecting cholesteatoma recidivism in patients undergoing AE-AE surgery. Methods: The study involved 63 patients who underwent AE-AE surgery for primary acquired cholesteatoma and were followed up clinically and radiologically for at least five years. The radiological follow-up included a non-EPI-DWI MRI. Results: Results showed that the AE-AE technique successfully treated cholesteatomas, with a recidivism rate of 5.2%. The study also found that non-EPI-DWI MRI was a useful diagnostic tool for detecting cholesteatoma recidivism, although false positives could occur due to the technique's high sensitivity. As Preoperative Pure-tone average (PTA) increases, there is a higher probability of cholesteatoma recidivism in imaging tests (p = 0.003). Conclusions: Overall, the study highlights the importance of the AE-AE surgical technique and non-EPI-DWI MRI in managing cholesteatoma recidivism in patients, providing valuable insights into associated risk factors and how to manage recidivism. Non-EPI-DWI MRI can assist in patient selection for revision surgery, reducing unnecessary interventions and associated risks while improving treatment outcomes and patient care.
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Affiliation(s)
- Natalia Díaz Zufiaurre
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | - Marta Calvo-Imirizaldu
- Radiology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (M.C.-I.); (P.D.-E.)
| | - Joan Lorente-Piera
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | | | | | - Manuel Manrique
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
| | - Raquel Manrique-Huarte
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Spain; (N.D.Z.); (M.M.); (R.M.-H.)
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Chau IY, Chou JS, Hsueh CJ. Epidermoid Cyst of the Maxillary Sinus: A Case Report and Literature Review. Ear Nose Throat J 2024:1455613241249054. [PMID: 38676551 DOI: 10.1177/01455613241249054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024] Open
Abstract
Epidermoid cysts are rare benign lesions that can derive from abnormally situated ectodermal tissue during embryological development or from implanted epithelium after trauma or surgery. In the oral and maxillofacial regions, epidermoid cysts usually develop in the floor of the mouth and rarely in other sites. We describe a rare case of an epidermoid cyst arising in the right maxillary sinus. A 29-year-old man with a known diagnosis of Marfan syndrome presented with progressive swelling and tenderness in the right buccal region, mimicking facial cellulitis, and refractory to medical treatment. Computed tomography scan showed a cystic lesion extending widely into the right maxillary sinus. The cyst was successfully removed with a medial maxillectomy through inferior antrostomy approach under general anesthesia. Histological examination confirmed the diagnosis of an epidermoid cyst, showing a cystic wall lined with a thin layer of keratinizing squamous epithelium and fibroma connective tissue infiltrated with inflammatory cells, with no skin appendages. There has been no evidence of recurrence during the 4 year follow-up. We also conduct a review of the English literature for the reported cases of maxillary epidermoid cyst.
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Affiliation(s)
- Ivy Yenwen Chau
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jiann-Shang Chou
- Department of Pathology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chih-Jen Hsueh
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
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Patel TA, Ettyreddy A, Cheng T, Smith K, Sridharan SS, McCall AA. Cost-Effectiveness of Diffusion Weighted MRI Versus Planned Second-Look Surgery for Cholesteatoma. Ann Otol Rhinol Laryngol 2024:34894241250253. [PMID: 38676449 DOI: 10.1177/00034894241250253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
OBJECTIVE To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. METHODS A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. RESULTS Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. CONCLUSION Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Terral A Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Abhinav Ettyreddy
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tracy Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth Smith
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Shaum S Sridharan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew A McCall
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fong JB, McCool RR. Titanium Implant Obscuring Residual Cholesteatoma on Magnetic Resonance Imaging: A Case Report. Ear Nose Throat J 2024:1455613241241112. [PMID: 38587331 DOI: 10.1177/01455613241241112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Cholesteatomas are benign growths of squamous epithelial tissue in the middle ear resulting in conductive hearing loss and/or erosion of the structures of the middle ear space. These lesions are surgically removed but require postoperative surveillance due to risk of recurrence or residual disease. Second-look surgery remains the gold standard for diagnosis and treatment of residual or recurrent cholesteatoma; however, advanced imaging modalities such as non-echoplanar diffusion weighted magnetic resonance imaging (non-EPI DWI-MRI) offer a less invasive alternative for surveillance. As surgeons become more reliant on advanced imaging, it is important to understand the limitations of the technology. We present a case of a delay in diagnosis of residual cholesteatoma due to a false-negative finding on non-EPI DWI-MRI screening in the presence of a titanium implant.
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Affiliation(s)
- Justin B Fong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ryan R McCool
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Surgery, Section of Otolaryngology, Audiology and Maxillofacial Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Erfurt C, Westerhout SF, Straatman LV, Smit AL, Stokroos RJ, Thomeer HGXM. Canal-wall up cholesteatoma surgery with mastoid obliteration leads to lower rates of disease recurrence without affecting hearing outcomes. Front Surg 2024; 11:1381481. [PMID: 38650663 PMCID: PMC11033303 DOI: 10.3389/fsurg.2024.1381481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Objectives The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques. Methods A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) (p = 0.013). Interventions All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma. Main outcome measures The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing. Results In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p = 0.903). Conclusions Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups.
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Affiliation(s)
- Chiara Erfurt
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne F. Westerhout
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Louise V. Straatman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J. Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hans G. X. M. Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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Alanazy S, Cho SI. Extensive Pneumocephalus Secondary to Petrous Bone Cholesteatoma. Ear Nose Throat J 2024; 103:248-251. [PMID: 34587824 DOI: 10.1177/01455613211048966] [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
Pneumocephalus refers to air inside the cranium; however, otogenic pneumocephalus is rarely reported in the literature. The neurological presentations of pneumocephalus include headache, lethargy, confusion, disorientation, and seizure. Here, we have reported a case of a 42-year-old woman with extensive pneumocephalus and cerebrospinal fluid leak secondary to petrous bone cholesteatoma. She presented to the emergency department with sudden headache and left ear discharge. Physical examination revealed watery otorrhea through a hole in the tympanic membrane. Radiological studies demonstrated extensive soft tissue in the left middle ear and mastoid extending to the internal auditory canal. Free intracranial air was observed, and bony destruction was seen in the cochlea, vestibule, and semicircular canals. The patient was managed surgically via the transotic approach and fully recovered. Although otogenic pneumocephalus is rarely encountered in clinical practice, early diagnosis and urgent management are important to prevent fatal complications.
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Affiliation(s)
- Sultan Alanazy
- Department of Otolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Sung Il Cho
- Department of Otolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
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Abaturovas R, Jakstas T, Talijūnas A, Balseris S, Arechvo I. Cholesteatoma Complicated by Parapharyngeal Abscess That Occurred After Temporal Bone Fracture. Cureus 2024; 16:e57523. [PMID: 38707133 PMCID: PMC11066707 DOI: 10.7759/cureus.57523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Parapharyngeal abscess as a cervical complication of chronic otitis media with cholesteatoma is extremely rare. We present the case of a patient with chronic otitis media and cholesteatoma who developed a parapharyngeal abscess following a blunt head trauma. A 65-year-old man with a history of recurrent right purulent otorrhea presented with symptoms of profuse purulent otorrhea, headache, hoarseness, and difficulty swallowing. Imaging revealed the presence of a right parapharyngeal abscess alongside a temporal bone fracture, suggesting a potential direct spreading route of aggressive chronic suppurative otitis media infection through the bone fracture defects to the parapharyngeal space. The patient underwent abscess drainage via a transcervical approach with simultaneous emergency radical mastoidectomy. Despite the development of septic shock with acute renal failure in the postoperative period, the patient made a full recovery.
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Affiliation(s)
- Rokas Abaturovas
- Department of Otorhinolaryngology, Faculty of Medicine, Medical Academy, Vilnius University, Vilnius, LTU
| | - Tomas Jakstas
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
| | - Andrius Talijūnas
- Center of Oral and Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic, Vilnius, LTU
| | - Svajunas Balseris
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
| | - Irina Arechvo
- Department of Otorhinolaryngology, Republican Vilnius University Hospital, Vilnius, LTU
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Yazama H, Kunimoto Y, Hasegawa K, Watanabe T, Fujiwara K. Characteristics of repeated recidivism in surgical cases of cholesteatoma requiring canal wall reconstruction. Ear Nose Throat J 2024; 103:234-240. [PMID: 34597528 DOI: 10.1177/01455613211048575] [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: 11/16/2022] Open
Abstract
OBJECTIVE Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction. METHODS We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated. RESULTS Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11-39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12-57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause. CONCLUSION For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary.
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Affiliation(s)
- Hiroaki Yazama
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | | | - Tasuku Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Motta G, Massimilla EA, Allosso S, Mesolella M, De Luca P, Testa D, Motta G. Critical Steps and Common Mistakes during Temporal Bone Dissection: A Survey among Residents and a Step-by-Step Guide Analysis. J Pers Med 2024; 14:349. [PMID: 38672976 PMCID: PMC11051255 DOI: 10.3390/jpm14040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for the learning and training of the young oto-surgeon in order to perform middle ear surgery, which includes the management of inflammatory pathology, hearing rehabilitation, and also cognitive decline prevention surgery. The primary objective of this study was to identify common mistakes and critical passages during the initial steps of temporal bone dissection, specifically cortical mastoidectomy and posterior tympanotomy. METHODS A survey among 100 ENT residents was conducted, gathering insights into the most prevalent errors encountered during their training to uncover the most challenging aspects faced by novice surgeons during these procedures. RESULTS The most common mistakes included opening the dura of the middle cranial fossa (MCF), injury of the sigmoid sinus (SS), chorda tympani (CT), and facial nerve (FN) injury while performing the posterior tympanotomy. The most important critical steps to prevent mistakes are related to the absence of wide exposure during cortical mastoidectomy and the consequent impossibility of identifying the landmarks of the facial recess before performing posterior tympanotomy. Injury of these structures was more common in younger surgeons and in the ones who performed less than five temporal bone dissection courses. CONCLUSIONS Numerous temporal bone dissections on cadavers are mandatory for ENT residents looking forward to performing middle ear surgery.
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Affiliation(s)
- Giovanni Motta
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (E.A.M.); (D.T.); (G.M.)
| | - Eva Aurora Massimilla
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (E.A.M.); (D.T.); (G.M.)
| | - Salvatore Allosso
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy; (S.A.); (M.M.)
| | - Massimo Mesolella
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy; (S.A.); (M.M.)
| | - Pietro De Luca
- Head and Neck Department, Isola Tiberina-Gemelli Isola Hospital, 00186 Rome, Italy;
| | - Domenico Testa
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (E.A.M.); (D.T.); (G.M.)
| | - Gaetano Motta
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy; (E.A.M.); (D.T.); (G.M.)
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Cao M, Xu T, Jiang W, Chen C, Yang H, Man R, Yu S. Selection of a Surgical Approach for Middle Ear Cholesteatoma Based on the Fusion Images of Non-Echo Planar Diffusion-Weighted MRI and CT. Ann Otol Rhinol Laryngol 2024:34894241241189. [PMID: 38511228 DOI: 10.1177/00034894241241189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE This study aimed to explore the ability of fusion images of non-echo planar diffusion-weighted magnetic resonance imaging (non-EPI-DWI MRI) and computed tomography (CT) to accurately locate cholesteatoma and plan the surgical approach. METHODS In the first part, 41 patients were included. Their CT images and non-EPI DWMRI images were fused. The scope of cholesteatoma in the fusion image was compared with that in the surgical video to evaluate the capability to locate cholesteatoma. A total of 229 patients were included in the second part, and they were divided into 2 groups. We chose the surgical approach for the CT group and the fusion group, and compared the accuracy of surgical approaches in the CT group and the fusion group using the surgical records. RESULTS The location of cholesteatoma shown in the fusion images was almost identical to that observed during the operation (kappa = .862). The overall specificity and sensitivity of the fusion images in locating cholesteatoma were 94.12% and 93.06%, respectively. The accuracy of surgical approach selection based on the fusion images (99.02%) was higher than that of surgical approach selection based on the CT images (85.83%). CONCLUSION It is recommended that the fusion images be used to locate the range of the cholesteatoma before operation.
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Affiliation(s)
- Maorong Cao
- Department of Otolaryngology, Shengli Oilfield Central Hospital, Dong'ying, Shandong, China
| | - Tong Xu
- Department of Otolaryngology, Qingdao Third People's Hospital Affiliated to Qingdao University, Qing'dao, Shandong, China
| | - Wen Jiang
- The First Faculty of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong, China
| | - Chengfang Chen
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Huiming Yang
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Rongjun Man
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
| | - Shudong Yu
- Department of Otolaryngology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China
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Gkrinia E, Brotis AG, Vallianou K, Ntziovara AM, Hajiioannou J. Otogenic brain complications: a systematic review and meta-analysis. J Laryngol Otol 2024:1-10. [PMID: 38440882 DOI: 10.1017/s0022215124000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications. METHODS A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually. RESULTS Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent. CONCLUSION Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment.
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Affiliation(s)
- Eleni Gkrinia
- ENT Department, University Hospital of Larissa, Larissa, Greece
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Kopczyk R, Jurkiewicz D, Rogowski M, Szydłowski M, Wierzbicka M. Off-label drugs in otolaryngological practice against the background of legal conditions of Polish legislation. Otolaryngol Pol 2024; 78:36-43. [PMID: 38332710 DOI: 10.5604/01.3001.0054.1185] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
<b><br>Introduction:</b> 'Off-label drug use' refers to the administration of drugs for unapproved indications or age groups, a different dosage or other form of administration. Considering the legal issues, there clearly exists a need to implement rules that would regulate the use of pharmaceuticals outside the scope of a marketing authorisation. The brevity and diversity of Polish laws in the field of health care leads to many interpretative doubts associated with particular legal acts.</br> <b><br>Aim:</b> We aimed to present clinical examples from everyday practice of off-label drug use from the medical and legal perspectives, and to support it with relevant legal acts.</br> <b><br>Material and method:</b> Off-label drug use in various otolaryngology subspecialties - otology (mesna), laryngology (bevacizumab, cidofovir and botulinum toxin) and head and neck surgery (botulinum toxin) - are presented and discussed in detail.</br> <b><br>Results:</b> Fourteen Polish legal acts regarding off-label drug use and 4 from EU legislation are commented on. The algorithm of cascade of decision-making processes in off-label drug use is shown.</br> <b><br>Conclusions:</b> Off-label use of medicinal products is not prohibited in Poland or the EU; nevertheless, it is undeniable that the unclear legal situation regarding the use of medicinal products for nonregistered indications creates difficulties. To minimise a doctor's liability risk, obtaining the informed consent from the patient for such treatment is advisable.</br>.
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Affiliation(s)
- Renata Kopczyk
- Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Dariusz Jurkiewicz
- Clinic of Otolaryngology and Oncological Otolaryngology with the Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Poland
| | - Maciej Szydłowski
- Wroclaw Regional Specialist Hospital, Research & Development Centre, Wrocław, Poland
| | - Małgorzata Wierzbicka
- Wroclaw University of Science and Technology, Wroclaw, Poland, Wroclaw Regional Specialist Hospital, Research & Development Centre, Wrocław, Poland
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15
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Kim YJ, Rim HS, Kim JH, Kim SS, Yeo JH, Yeo SG. Autophagy Genes and Otitis Media Outcomes. Clin Pract 2024; 14:293-304. [PMID: 38391409 PMCID: PMC10888475 DOI: 10.3390/clinpract14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Otitis media (OM) is a common cause of hearing loss in children that requires corrective surgery. Various studies have investigated the pathomechanisms and treatment of OM. Autophagy, an essential cellular recycling and elimination mechanism implicated in various diseases, is known to play an important role in the pathogenesis of OM. Here, we conducted a literature review on autophagy in OM, highlighting the relationship between expression patterns of autophagy-related factors and pathophysiological and clinical aspects of OM. We summarized the existing research results on the expression of autophagy-related factors in acute OM (AOM), OM with effusion (OME), chronic OM (COM) with cholesteatoma, and COM without cholesteatoma (CholeOM) in animals and humans. Autophagy-related factors are expressed in the middle ear mucosa or fluid of AOM, effusion of OME, granulation tissue of COM, and cholesteatoma of CholeOM. Among ATGs and other autophagy-related factors, the most extensively studied in relation to the pathogenesis of OM are mTOR, LC3II/I, PI3K, Beclin-1, FLIP, Akt, and Rubicon. Expression of autophagy-related factors is associated with AOM, OME, COM, and CholeOM. Inadequate expression of these factors or a decrease/increase in autophagy responses can result in OM, underscoring the critical role of ATGs and related factors in the pathogenesis of OM.
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Affiliation(s)
- Yong Jun Kim
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hwa Sung Rim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
| | - Jeong Hee Kim
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sung Soo Kim
- Department of Biochemistry and Molecular Biology, College of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Joon Hyung Yeo
- Public Health Center, Danyang-gun, Seoul 27010, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea
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Lili L, Fei H, Hui H, Liyong Q. Granular Cell Tumor in Auditory Meatus: A Case Report. Ear Nose Throat J 2024; 103:87-89. [PMID: 34420421 DOI: 10.1177/01455613211038234] [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: 11/15/2022] Open
Abstract
Granular cell tumor (GCT) is a rare benign soft tissue neoplasm that develops primarily in the skin and subcutaneous tissue of the head and neck, frequently in the tongue, but has not been observed in the auditory meatus. These tumors generally present as slow-growing nodules with few unique clinical or radiological features, and so must be confirmed by pathological examination. Here, we present the case of a 62-year-old female with right hearing loss and benign GCT in the right auditory meatus initially misdiagnosed as cholesteatoma.
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Affiliation(s)
- Le Lili
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhejiang, China
| | - Huang Fei
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhejiang, China
| | - He Hui
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhejiang, China
| | - Qian Liyong
- Department of Pathology, Zhoushan Hospital of Zhejiang Province, Zhejiang, China
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Mahajan N, Vijayendra VK, Redleaf M, Honnurappa V. Endoscopic classification system of pars tensa retractions. J Laryngol Otol 2024; 138:136-141. [PMID: 37340960 DOI: 10.1017/s0022215123001123] [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: 06/22/2023]
Abstract
BACKGROUND Previous classification systems of pars tensa retractions have not consistently incorporated ossicular erosion or the presence of cholesteatoma. OBJECTIVE This study aimed to illustrate our classification of pars tensa retractions, which is more precise than previous systems, with aided use of the endoscope. METHODS A retrospective study was carried out on 200 ears of 170 patients whose pars tensa retractions had been documented at a tertiary otological referral centre. RESULTS A classification system was developed. Pars tensa retractions were divided into the following subcategories: grade 0, grade 1, grade 2a, grade 2b, grade 3a, grade 3b, grade 3c, grade 4a, grade 4b, grade 4c, grade 5a, grade 5b and grade 5c. CONCLUSION This classification system was able to accommodate all pars tensa retractions. The distribution of grades of pars tensa retractions was based on ossicular status and the presence or absence of cholesteatoma. It is therefore a more applicable, and functionally based system than previous alternatives.
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Affiliation(s)
- Nilesh Mahajan
- Vijaya ENT Care Centre, Superspeciality Otology Centre, Bangalore, India
| | | | - Miriam Redleaf
- Otology/Neurotology, University of Illinois Hospitals - Chicago, Chicago, IL, USA
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18
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Kalavacherla S, Du E, de Cos V, Meller L, Ostrander B, Davis M, Greene J. The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort. Laryngoscope 2024; 134:911-918. [PMID: 37470296 PMCID: PMC11023743 DOI: 10.1002/lary.30895] [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: 01/24/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses. METHODS A de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included. RESULTS Among the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001). CONCLUSIONS In one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months. LEVEL OF EVIDENCE 4 Laryngoscope, 134:911-918, 2024.
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Affiliation(s)
- Sandhya Kalavacherla
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric Du
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Víctor de Cos
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Meller
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Benjamin Ostrander
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Morgan Davis
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Jacqueline Greene
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
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19
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James AL. Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach. J Clin Med 2024; 13:836. [PMID: 38337530 PMCID: PMC10856742 DOI: 10.3390/jcm13030836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children. METHODS Review of children with primary acquired or congenital cholesteatoma. Severity was classified by extent and EAONO-JOS stage, and surgery by SAMEO-ATO. Primary outcome measure was 5-year recurrence rate using Kaplan-Meier or Cox regression analysis. RESULTS Median age was 10.7 years for 408 cholesteatomas from which 64 recurred. Median follow up was 4.6 years (0-13.5 years) with 5-year recurrence rate of 16% and 10-year of 29%. Congenital cholesteatoma (n = 51) had 15% 5-year recurrence. Of 216 pars tensa cholesteatomas, 5-year recurrence was similar at 14%, whereas recurrence from 100 pars flaccida cholesteatomas was more common at 23% (log-rank, p = 0.001). Sub-division of EAONO-JOS Stage 2 showed more recurrence in those with than without mastoid cholesteatoma (22.1% versus 10%), with more in Stage 3 (31.9%; p = 0.0003). Surgery without mastoidectomy, including totally endoscopic ear surgery, had 11% 5-year recurrence. Canal wall-up tympanomastoidectomy (CWU) and canal wall-down/mastoid obliteration both had 23% 5-year recurrence. Multivariate analysis showed increased recurrence for EAONO-JOS Stage 3 (HR 5.1; CI: 1.4-18.5) at risk syndromes (HR 2.88; 1.1-7.5) and age < 7 years (HR 1.9; 1.1-3.3), but not for surgical category or other factors. CONCLUSION Young age and more extensive cholesteatoma increase the risk of recurrent cholesteatoma in children. When controlling for these factors, surgical approach does not have a significant effect on this outcome. Other objectives, such as lower post-operative morbidity and better hearing outcome, may prove to be more appropriate parameters for selecting optimal surgical approach in children.
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Affiliation(s)
- Adrian L. James
- Department of Otolaryngology—Head & Neck Surgery, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Division of Otology & Neurotology, Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada
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20
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Lou Z, Lou Z, Chen Z. Cartilage-Perichondrium Myringoplasty for Managing Intratympanic Membrane Cholesteatomas With Chronic Otitis Media in Adults. Ear Nose Throat J 2024:1455613241227714. [PMID: 38279828 DOI: 10.1177/01455613241227714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024] Open
Abstract
Objective: This study evaluated the surgical outcomes and complications of the endoscopic cartilage-perichondrium graft technique for treating intratympanic membrane cholesteatomas (ITMCs) with tympanic membrane (TM) perforation or an atrophic TM in adults. Methods and Materials: Clinical data on 11 adult ITMCs were analyzed retrospectively. The graft success and cholesteatoma recurrence were evaluated 12 months postoperatively. Results: Of the 11 patients with ITMC, TM perforation had occurred in 2 (18.2%) and an atrophic TM or TM scar healing occurred in 9 (81.8%). In endoscopy, keratin debris accumulation was seen at the superior edge of the perforation or atrophic TM. Computed tomography revealed that the cholesteatoma was confined to the TM. Intraoperatively, the epithelial invasion of the cholesteatoma was limited to the fibrous layer within the TM. Cartilage-perichondrium grafting was performed after removing the cholesteatoma. All the grafts were successful, and the perforations achieved complete closure by the final 12 month follow-up. Endoscopy revealed no recurrent cholesteatoma. Of the 9 patients with preoperative tinnitus, the tinnitus disappeared in 3 (33.3%), was relieved in 4 (44.4%), and was unchanged in 2 (22.2%). Of the 7 patients with an ear fullness preoperatively, the ear fullness disappeared in 6 (85.7%) and was relieved in 1 (14.3%). The mean air-bone gap improved from 28.6 dB preoperatively to 16.2 dB postoperatively. Conclusions: Endoscopic complete excision of an ITMC and cartilage-perichondrium graft without raising a tympanomeatal flap can lead to successful graft intake and improve the symptoms for the patients with ITMC combined with perforation or atrophic TM.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu, Zhejiang, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Lab Sleep Disordered Breathing, Shanghai, China
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21
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Zhao C. Comparison of the Extended Perichondrium-Cartilage Butterfly Inlay Technique and Over-Underlay Technique for Repairing Subtotal Perforation: A 2-Year Follow-up Study. Ear Nose Throat J 2024:1455613231225614. [PMID: 38205768 DOI: 10.1177/01455613231225614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To compare graft outcomes and postoperative complications between the extended perichondrium-cartilage butterfly inlay (PCBI) technique and the perichondrium-cartilage over-underlay (PCOU) technique for repairing subtotal perforations over a 2-year follow-up period. METHODS AND MATERIALS Patients with subtotal perforations were prospectively randomized to either the extended PCBI (n = 52) or PCOU (n = 51) group. Evaluation metrics included operation time, graft success rate, hearing gain, and complications at 24 months postoperatively. RESULTS The study included 103 patients with 103 ears. Follow-up loss occurred in 11 of 52 patients (21.2%) in the PCBI group and 13 of 51 patients (25.5%) in the PCOU group (P = .773). The final analysis included 41 of 52 patients (78.9%) in the PCBI group and 38 of 51 patients (74.5%) in the PCOU group. The average operation time was significantly shorter in the PCBI group (31.2 ± 1.9 min) compared to the PCOU group (52.8 ± 6.3 min, P < .001). At 24 months postoperatively, the graft success rate was 82.9% (34 patients) in the PCBI group and 92.1% (35 patients) in the PCOU group (P = .374). No significant group difference was noted in mean air-bone gap (ABG) gain (P = .759). High-resolution computed tomography (HRCT) demonstrated well-pneumatized mastoids and middle ears in both groups. Altered taste was reported in no PCBI group patients and 23.7% (9 patients) of the PCOU group patients (P < .05). Graft cholesteatoma was found in 4.9% (two patients) in the PCBI group and 7.9% (three patients) in the PCOU group (P = .930). CONCLUSION The endoscopic extended PCBI technique is safe and effective for repairing subtotal perforation. It avoids raising a tympanomeatal flap and demonstrates high long-term graft success with minimal complications.
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Affiliation(s)
- Chaowei Zhao
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, Yiwu City, Zhejiang Province, China
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22
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Peng Q, Liu K, Wang M, Zhou C, Zhang S, Liu Y, Xie B. Post-operative vestibular and equilibrium evaluation in patients with cholesteatoma-induced labyrinthine fistulas. J Laryngol Otol 2024; 138:16-21. [PMID: 37650309 DOI: 10.1017/s0022215123000671] [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 compare the pre- and post-operative vestibular and equilibrium functions of patients with cholesteatoma-induced labyrinthine fistulas who underwent different management methods. METHODS Data from 49 patients with cholesteatoma-induced labyrinthine fistulas who underwent one of three surgical procedures were retrospectively analysed. The three management options were fistula repair, obliteration and canal occlusion. RESULTS Patients underwent fistula repair (n = 8), canal occlusion (n = 18) or obliteration procedures (n = 23). Patients in the fistula repair and canal occlusion groups suffered from post-operative vertigo and imbalance, which persisted for longer than in those in the obliteration group. Despite receiving different management strategies, all patients achieved complete recovery of equilibrium functions through persistent efforts in rehabilitation exercises. CONCLUSION Complete removal of the cholesteatoma matrix overlying the fistula is reliable for preventing iatrogenic hearing deterioration due to unremitting labyrinthitis. Thus, among the three fistula treatments, obliteration is the optimal method for preserving post-operative vestibular functions.
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Affiliation(s)
- Q Peng
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - K Liu
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - M Wang
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - C Zhou
- Department of Otolaryngology, Shangrao Municipal Hospital, Shangrao, China
| | - S Zhang
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - Y Liu
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
| | - B Xie
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, China
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Zaman SU, Rangankar VP, Krishnarjun M, Kalekar TM, Shah VP, Pawar R, Kulothungan G. Readout-Segmented Echoplanar (RESOLVE) Diffusion-Weighted Imaging on 3T MRI in Detection of Cholesteatoma-Our Experience. Indian J Radiol Imaging 2024; 34:16-24. [PMID: 38106850 PMCID: PMC10723965 DOI: 10.1055/s-0043-1776054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background Several research studies have demonstrated the utility of diffusion-weighted imaging (DWI) in detecting middle ear cholesteatomas, especially with the non-echoplanar imaging (non-EPI) DWI technique. REadout Segmentation Of Long Variable Echo trains (RESOLVE), a multishot-EPI DWI, has better spatial resolution at a thinner section acquisition with reduced image distortion compared to the single-shot-EPI DWI technique. Purpose In this study, we evaluated the diagnostic ability of RESOLVE -DWI in middle ear cholesteatomas with surgical and histopathological support. Patients and Methods Fifty patients with clinical suspicion of primary cholesteatoma or postoperative recurrence were subjected to routine sequences and RESOLVE-DWI on magnetic resonance imaging (MRI). Thirty-eight patients had unilateral disease, while 12 patients had bilateral disease. The bilateral temporal bones of 50 patients were evaluated on MRI. The results attained by RESOLVE-DWI were correlated with intraoperative and histopathological findings. Results RESOLVE-DWI truly detected 55 of the 58 surgically proven cholesteatomas. RESOLVE-DWI could not detect three cholesteatoma lesions due to their small size and falsely diagnosed one case each of impacted wax and non-cholesteatomatous otitis media as cholesteatoma. With a 95% confidence interval, RESOLVE-DWI showed 94.8% sensitivity, 95.2% specificity, 96% positive predictive value, 93% negative predictive value, and 95% diagnostic accuracy in cholesteatoma detection. Conclusion RESOLVE-DWI is a sensitive and specific DWI technique for detecting middle ear cholesteatoma. However, RESOLVE-DWI has limitations in the diagnosis of small (<3 mm) cholesteatomas.
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Affiliation(s)
- Sameeh Uz Zaman
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
| | - Varsha P. Rangankar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Muralinath Krishnarjun
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Tushar M. Kalekar
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Viraj Pankaj Shah
- Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, Maharashtra, India
| | - Rishikesh Pawar
- Seth A.J.B ENT Municipal Hospital, Mumbai, Maharashtra, India
| | - Gowtham Kulothungan
- Shri Sathya Sai Medical College and Hospital, Chengalpattu, Tamil Nadu, India
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Daoudi H, Levy R, Baudouin R, Couloigner V, Leboulanger N, Garabédian EN, Belhous K, Boddaert N, Denoyelle F, Simon F. Performance of Non-EPI DW MRI for Pediatric Cholesteatoma Follow-Up. Otolaryngol Head Neck Surg 2024; 170:221-229. [PMID: 37313857 DOI: 10.1002/ohn.398] [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: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the accuracy, sensitivity, and specificity of nonecho planar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) to detect residual cholesteatoma in children. STUDY DESIGN Retrospective study. SETTING Tertiary comprehensive hospital. METHODS Children operated on for a first-stage cholesteatoma procedure from 2010 to 2019 were included. MRIs were performed with non-EPI DW sequences. Initial reports were collected, indicating the presence or absence of hyperintensity suggestive of cholesteatoma. Three hundred twenty-three MRIs were correlated with the subsequent surgery (66%) or year-later MRI (21%), or were considered accurate if performed 5 years or more after the last surgery (13%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging procedure for the detection of cholesteatoma were calculated. RESULTS Two hundred twenty-four children with mean age of 9 ± 4 years old presented with cholesteatoma. MRIs were performed 27 ± 24 months after surgery. Residual cholesteatoma was diagnosed in 35%. The sensitivity, specificity, PPV, and NPV of MRI were 62%, 86%, 74%, and 78%, respectively. Accuracy, sensitivity, and specificity increased significantly over time (multivariate analysis). The mean delay after last surgery was of 30 ± 2.0 months for accurate MRI (true positive or negative) versus 17 ± 2.0 months for nonaccurate (false positive or negative) MRIs (p < .001). CONCLUSION However, long the delay after the last surgery, the sensitivity of non-EPI diffusion sequence MRI in children has limitations for the detection of residual cholesteatoma. Surveillance for residual cholesteatoma should incorporate findings at primary surgery, surgeon experience, a low threshold for second-look procedures, and routine imaging.
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Affiliation(s)
- Hannah Daoudi
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Raphaël Levy
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Robin Baudouin
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Leboulanger
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eréa-Noel Garabédian
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Kahina Belhous
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Nathalie Boddaert
- Department of Paediatric Radiology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, Assistance Publique Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France
- UMR-1163 Institut Imagine, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
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Marom T, Swords WE, Santos-Cortez RLP. Editorial: Otitis media susceptibility due to genetic variants. Front Genet 2023; 14:1341669. [PMID: 38152651 PMCID: PMC10752497 DOI: 10.3389/fgene.2023.1341669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University of the Negev, Ashdod, Israel
| | - W. Edward Swords
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama, Birmingham, AL, United States
| | - Regie Lyn P. Santos-Cortez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, CO, Aurora, United States
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Kloth C, Beck A, Sollmann N, Beer M, Horger M, Thaiss WM. Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications-Pictorial Review. Tomography 2023; 9:2190-2210. [PMID: 38133074 PMCID: PMC10747582 DOI: 10.3390/tomography9060170] [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: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given.
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Affiliation(s)
- Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Radiology and Radiation Therapy Lindau, Friedrichshafener Str. 83, 88131 Lindau (Lake Constance), Germany
| | - Annika Beck
- Institute of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany;
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (N.S.); (M.B.); (W.M.T.)
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [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: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
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Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Łuczak MW, Dżaman K, Zaręba Ł, Czerwaty K, Siewiera J, Głuszko A, Olszewska E, Brzost J, Kantor I, Szczepański MJ, Ludwig N. HMGB1 Carried by Small Extracellular Vesicles Potentially Plays a Role in Promoting Acquired Middle Ear Cholesteatoma. Diagnostics (Basel) 2023; 13:3469. [PMID: 37998605 PMCID: PMC10669961 DOI: 10.3390/diagnostics13223469] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Cholesteatoma is a specific medical condition involving the abnormal, non-cancerous growth of skin-like tissue in the middle ear, potentially leading to a collection of debris and even infections. The receptor for advanced glycation (RAGE) and its ligand, high-mobility box 1 (HMGB1), are both known to be overexpressed in cholesteatoma and play a potential role in the pathogenesis of the disease. In this study, we investigated the role of small extracellular vesicles (sEVs) in carrying HMGB1 and inducing disease-promoting effects in cholesteatoma. No significant differences in the concentration of isolated sEVs in the plasma of cholesteatoma patients (n = 17) and controls (n = 22) were found (p > 0.05); however, cholesteatoma-derived sEVs carried significantly higher levels of HMGB1 (p < 0.05). In comparison to sEVs isolated from the plasma of controls, cholesteatoma-derived sEVs significantly enhanced keratinocyte proliferation and IL-6 production (p < 0.05), potentially by engaging multiple activation pathways including MAPKp44/p42, STAT3, and the NF-κB pathway. Thus, HMGB1(+) sEVs emerge as a novel factor potentially promoting cholesteatoma progression.
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Affiliation(s)
- Michał W. Łuczak
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI 02906, USA;
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Łukasz Zaręba
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Katarzyna Czerwaty
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Jacek Siewiera
- Department of Hyperbaric Medicine, Military Institute of Medicine-National Research Institute, 00-902 Warsaw, Poland;
| | - Alicja Głuszko
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Jacek Brzost
- Department of Otolaryngology, The Children’s Memorial Health Institute, 00-328 Warsaw, Poland;
| | - Ireneusz Kantor
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Mirosław J. Szczepański
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland; (Ł.Z.); (A.G.)
- Department of Otolaryngology, Centre of Postgraduate Medical Education, 02-097 Warsaw, Poland; (K.D.); (K.C.); (I.K.)
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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Boesoirie SF, Hasansulama W, Lasminingrum L, Novianto AT, Gatera VA, Aroeman NA, Boesoirie TS. The Role of Vitamins A and E Level in Chronic Suppurative Otitis Media with and without Cholesteatoma. J Multidiscip Healthc 2023; 16:3435-3442. [PMID: 38024126 PMCID: PMC10645589 DOI: 10.2147/jmdh.s414115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Aim High expression of lytic enzymes and cytokines is related to cell proliferation in Otitis Media Chronic Suppurative (CSOM) with cholesteatoma. In addition, the process of inflammation healing and maintenance of homeostatic conditions requires Reactive Oxygen Species (ROS), which can cause significant damage to cells. To address this issue, secondary antioxidants such as Vitamins A and E are used to inhibit and neutralize the occurrence of oxidation reactions. These vitamins complement each other, with vitamin A working effectively at low concentrations of oxygen, while vitamin E functions in the opposite manner. Purpose This study aims to investigate the roles of vitamin A and E levels in CSOM patients with Cholesteatoma. Patients and Methods The study was conducted between July and December 2020, and the method used was an analytical observational approach with a case-control design. The sample population comprised 60 CSOM patients divided into 2 groups. These included those with and without cholesteatoma. Results The results showed that there was no significant difference between these two groups in terms of the impact of vitamin A and E levels (respectively, p = 0.626, p = 0.864). Conclusion Considering these results, it was discovered that vitamins A and E levels do not influence the occurrence of CSOM with or without cholesteatoma.
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Affiliation(s)
- Shinta Fitri Boesoirie
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Wijana Hasansulama
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Lina Lasminingrum
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Arif Tria Novianto
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Vesara Ardhe Gatera
- Department of Pharmacy and Health Sciences, Universiti Kuala Lumpur – Royal College of Medicine Perak, Ipoh, Perak, Malaysia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Nur Akbar Aroeman
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Thaufiq Siddiq Boesoirie
- Department of Otorhinolaryngology-Head and Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Schouwenaar EMM, Hellingman CA, Waterval JJ. Health-related quality of life after otologic surgical treatment for chronic otitis media: systematic review. Front Neurol 2023; 14:1268785. [PMID: 38020592 PMCID: PMC10654635 DOI: 10.3389/fneur.2023.1268785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This systematic review aims to describe the impact of otologic surgery as a treatment for chronic otitis media (COM) on the Health-Related Quality of Life (HRQoL) of adult patients. Methods A literature search was performed in PubMed, Scopus, Embase, and Web of Science until May 2023. Prospective studies including adult patients with COM (cholesteatoma) who underwent canal wall up mastoidectomy, canal wall down mastoidectomy, or tympanoplasty without mastoidectomy, with pre- and postoperative HRQoL measurements, were considered eligible. Questionnaire validation studies were excluded. The risk of bias and study quality were evaluated with a Quality Assessment Tool (for before-after studies with no control group). To assess the change in HRQoL, pre- and postoperative HRQoL values and absolute changes were extracted, synthesized, and presented in tables. Standardized mean differences (SMD) were calculated to enhance comparisons. Results Of the 720 studies identified, 16 met the inclusion criteria of this review. Different questionnaires were used throughout the studies. The CES and COMOT-15 were used in five studies and the ZCMEI-21 and COMQ-12 in three studies. All studies indicated statistically significant improvement in HRQoL from pre- to postoperative, measured with disease-specific HRQoL questionnaires. General HRQoL questionnaires did not show significant improvement. Calculated SMDs ranged from 0.24 to 6.99. Discussion and conclusion Included studies had low (n = 10) to high (n = 6) risk of bias and poor (n = 4), fair (n = 7) or good (n = 5) study quality. Surgical treatment positively impacts the HRQoL of adult COM patients with and without cholesteatoma. However, the clinical relevance of the reported changes is unknown due to the lack of minimal clinically important differences (MCID) or cut-off values in each questionnaire. Therefore, further research regarding the MCIDs of each questionnaire is needed. Future research should also report preoperative chief symptoms and indications for surgery to improve individual patient counseling.
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Affiliation(s)
- Esther M. M. Schouwenaar
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Catharine A. Hellingman
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jérôme J. Waterval
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Gargula S, Simon F, Bernardeschi D, Kania R, Denoyelle F, Ayache D, Daval M, Alciato L. French adaptation and validation of the Chronic Otitis Media Questionnaire-12 (COMQ-12). Int J Audiol 2023; 62:1011-1013. [PMID: 36345973 DOI: 10.1080/14992027.2022.2140314] [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: 05/20/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Chronic otitis media (COM) can seriously impact quality of life (QOL). Disease-specific questionnaires are essential for an accurate assessment of this impact. There is no questionnaire available for French-speaking patients with COM. This study aims to adapt and validate the French version of the COMQ-12 questionnaire. DESIGN This is a controlled, prospective study, conducted between May 2020 and December 2021. Translation was performed using a forward-backward technique, and statistical validation was performed with a COM patients and a controls adult cohorts. STUDY SAMPLE 100 patients (mean age 48 ± 16), and 50 controls (mean age 41 ± 16; p = 0.02) completed the test. RESULTS Internal consistency, assessed by Cronbach's alpha, was 0.870 for the cases group. The mean COMQ-12 total score was 23.92 ± 11.3 for cases versus 3.70 ± 6.15 for controls (p < 0.0001). Individual items all had high discriminatory performances. The three items concerning ear discharge (Q1, Q2, Q9) had weaker correlation with the other items and the global score, but did not have a negative impact on internal consistency. CONCLUSION The French version of the COMQ-12 is a short and easy-to-use test, with robust statistical properties, for assessing QOL in patients with COM.
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Affiliation(s)
- Stéphane Gargula
- Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - François Simon
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Romain Kania
- Department of Otolaryngology, Hôpital Lariboisière, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Denis Ayache
- Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Mary Daval
- Department of Otolaryngology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Lauranne Alciato
- Department of Otolaryngology, Hôpital Pitié-Salpétrière, Paris, France
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McKenna D, Reddy E. Congenital mastoid-isolated cholesteatoma in a 14-year-old boy. Clin Case Rep 2023; 11:e8182. [PMID: 38028056 PMCID: PMC10654462 DOI: 10.1002/ccr3.8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 12/01/2023] Open
Abstract
Congenital mastoid confined cholesteatoma is a very rare entity with only 30 reported cases worldwide. We describe the presentation and treatment of this condition in a 14-year-old boy, with maintenance of normal hearing and ear canal function.
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Affiliation(s)
- Dominic McKenna
- Craigavon Area Hospital (Southern Health and Social Care Trust)PortadownUK
| | - Ekambar Reddy
- Craigavon Area Hospital (Southern Health and Social Care Trust)PortadownUK
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Qiu W, Chen P, Lv M, Zhu J, Wang Y, Zhao S. Diagnosis and treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative effusion in the middle ear and mastoid process. Acta Otolaryngol 2023; 143:940-945. [PMID: 38250795 DOI: 10.1080/00016489.2023.2299689] [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: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The optimal timing for surgery to promote postoperative recovery in children with congenital stenosis of the external auditory canal with external auditory canal cholesteatoma, who are susceptible to exudative inflammation of middle ear and mastoid process, is still uncertain. OBJECTIVES To investigate the treatment of congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with exudative inflammation. MATERIAL AND METHODS A retrospective analysis of 45 patients with congenital stenosis of external auditory canal with external auditory canal cholesteatoma complicated with mastoiditis. Based on whether effusion had resolved at the time of surgery, the patients were divided into two groups. Pure-tone audiometry tests were performed before and after surgery for both groups. RESULTS The average postoperative duration of dry ear was 36.38 days in Group 1 and 47.90 days in Group 2 (p < 0.05). Among patients who underwent hearing reconstruction, the average air conduction threshold decreased by 15-36 dBHL in Group 1 and by 7-22 dBHL in Group 2 (p < 0.05). CONCLUSIONS AND SIGNIFICANCE The postoperative outcomes of dry ear and hearing improvement can be enhanced by performing operation after effusion resolution in cases of congenital external auditory canal stenosis with external auditory canal cholesteatoma exudative inflammation.
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Affiliation(s)
- Wenxi Qiu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Peiwei Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Mengshuang Lv
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Jikai Zhu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Yuan Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
| | - Shouqin Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Ministry of Education Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing, China
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Honnurappa V, Mahajan N, Vijayendra VK, Vassiliu S, Redleaf M. Management of attic retraction pockets. J Laryngol Otol 2023; 137:1272-1276. [PMID: 37203214 DOI: 10.1017/s002221512300083x] [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: 05/20/2023]
Abstract
OBJECTIVE Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade. METHOD Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air-bone gap pure tone average were recorded. RESULTS Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II-V ears had surgical management. All 200 ears were followed up for 36-240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air-bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter. CONCLUSION Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing.
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Affiliation(s)
| | - Nilesh Mahajan
- Vijaya ENT Care Centre, Super Speciality Otology Centre, Bangalore, India
| | | | - Sofia Vassiliu
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Miriam Redleaf
- Otology/Neurotology, Department of Otolaryngology, University of Illinois Hospitals, Chicago, USA
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Donati G, Somers T, Van Havenbergh T, Falcioni M. Congenital Retrosigmoid Cholesteatoma: Case Series and Literature Review. J Int Adv Otol 2023; 19:396-401. [PMID: 37789626 PMCID: PMC10645185 DOI: 10.5152/iao.2023.22798] [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: 05/04/2022] [Accepted: 05/29/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND This study aimed to discuss 3 cases of congenital cholesteatoma located posterior to the sigmoid sinus, with no/minimal involvement of mastoid, and compare them with cases presented in the literature to better define this rare entity. METHODS Retrospective chart analysis of 3 congenital cholesteatomas located posterior to the sigmoid sinus treated surgically in 2 skull-base centers and literature review. Though congenital cholesteatoma can arise outside the middle ear, only a few cases presenting in the retrosigmoid occipital bone have been described earlier. RESULTS In all 3 patients, there was a delay in the presentation, as symptoms were nonspecific or lacking, leading in 1 case to severe complications. Computed tomography and magnetic resonance imaging, especially diffusion-weighted imaging scans, allowed accurate diagnosis and surgical planning. Surgery happened to be challenging due to the tight adherence of the cholesteatoma to the thinned dural surface. Complete excision was achieved in all the cases. CONCLUSION Congenital cholesteatoma located posterior to the sigmoid sinus is a rare entity and is even more exceptional after a critical review of the literature. Complete excision is quintessential to prevent intradural extension or infection. The most important surgical issue is the management of the posterior fossa dura and the sigmoid sinus. We recommend meticulous dissection with slow peeling of the epithelial lining from the dura. Bipolar coagulation of the dura may help in avoiding recidivism. Moreover, cerebrospinal fluid (CSF) leak during dissection has to be avoided as long as possible, because the loss of tension of the already thinned dura makes its peeling particularly difficult.
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Affiliation(s)
- Giulia Donati
- Department of Otorhinolaryngology and Otoneurosurgery, University Hospital of Parma, Parma, Italy
| | - Thomas Somers
- Department of ENT and Skull Base, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium
| | - Tony Van Havenbergh
- Department of Neurosurgey, Sint-Augustinus Hospital, Wilrijk, Antwerp, Belgium
| | - Maurizio Falcioni
- Department of Otorhinolaryngology and Otoneurosurgery, University Hospital of Parma, Parma, Italy
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宋 忠, 刘 文, 王 宁, 傅 莹, 李 泽, 王 春, 孙 永. [Clinical analysis of 11 cases of otogenic intracranial complications treated by multidisciplinary collaboration]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:819-824;828. [PMID: 37828887 PMCID: PMC10803237 DOI: 10.13201/j.issn.2096-7993.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 10/14/2023]
Abstract
Objective:To analyze the clinical diagnosis, treatment ,and surgical timing of otogenic intracranial complications. Methods:The clinical data of 11 patients with intracranial complications with ear symptoms as the first manifestation in Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University(Qingdao) from December 2014 to June 2022 were collected, including 8 males and 3 females, aged from 4 to 69 years. All patients had complete otoendoscopy, audiology, imaging and etiology examination, and the diagnosis and treatment plan was jointly developed through multidisciplinary consultation according to the critical degree of clinical symptoms and imaging changes. Among the 11 patients, 5 cases were treated with intracranial lesions first in neurosurgery department and middle ear lesions later in otolaryngology, 3 cases of meningitis, were treated with middle ear surgery after intracranial infection control, 1 case was treated with middle ear lesions and intracranial infection simultaneously, and 2 cases were treated with sigmoid sinus and transverse sinus thrombosis conservatively. They were followed up for 1-6 years. Descriptive statistical methods were used for analysis. Results:All the 11 patients had ear varying symptoms, including ear pain, pus discharge and hearing loss, etc, and then fever appeared, headache, disturbance of consciousness, facial paralysis and other intracranial complication. Otoendoscopy showed perforation of the relaxation of the tympanic membrane in 5 cases, major perforation of the tension in 3 cases, neoplasia in the ear canal in 1 case, bulging of the tympanic membrane in 1 case, and turbidity of the tympanic membrane in 1 case. There were 4 cases of conductive hearing loss, 4 cases of mixed hearing loss and 3 cases of total deafness. Imaging examination showed cholesteatoma of the middle ear complicated with temporal lobe brain abscess in 4 cases, cerebellar abscess in 2 cases, cholesteatoma of the middle ear complicated with intracranial infection in 3 cases, and sigmoid sinus thrombophlebitis in 2 cases. In the etiological examination, 2 cases of Streptococcus pneumoniae were cultured in the pus of brain abscess and cerebrospinal fluid, and 1 case was cultured in streptococcus vestibularis, Bacteroides uniformis and Proteus mirabilis respectively. During the follow-up, 1 patient died of cardiovascular disease 3 years after discharge, and the remaining 10 patients survived. There was no recurrence of intracranial and middle ear lesions. Sigmoid sinus and transverse sinus thrombosis were significantly improved. Conclusion:Brain abscess, intracranial infection and thrombophlebitis are the most common otogenic intracranial complications, and cholesteatoma of middle ear is the most common primary disease. Timely diagnosis, multidisciplinary collaboration, accurate grasp of the timing in the treatment of primary focal and complications have improved the cure rate of the disease.
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Affiliation(s)
- 忠义 宋
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 文杰 刘
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 宁 王
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 莹 傅
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 泽晶 李
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 春芳 王
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
| | - 永强 孙
- 山东大学齐鲁医院(青岛)耳鼻咽喉头颈外科(山东青岛,266035)Department of Otolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University, Qingdao, 266035, China
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Rutkowska J, Kasacka I, Rogowski M, Olszewska E. Immunohistochemical Identification and Assessment of the Location of Immunoproteasome Subunits LMP2 and LMP7 in Acquired Cholesteatoma. Int J Mol Sci 2023; 24:14137. [PMID: 37762439 PMCID: PMC10531666 DOI: 10.3390/ijms241814137] [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: 08/16/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Cholesteatoma, accompanied by chronic inflammatory response, is characterized by invasive growth and osteolytic activity. As specific proteasome isoforms, the immunoproteasomes serve as an important modulator of inflammatory responses. The aim of the present study was to determine the biological activity of cholesteatoma through the analysis of the expression and localization of immunoproteasome subunits of low molecule weight protein (LMP) 2 and LMP7. Cholesteatoma specimens were obtained from 15 adults who underwent ear surgery due to acquired attic cholesteatoma. Normal skin specimens were taken from retro-auricular skin incisions from the same patients. The specimens were stained with anti-LMP7 antibody, using immunohistochemistry techniques based on the binding of biotinylated secondary antibody with the enzyme-labeled streptavidin and the Envision FLEX system. In all specimens of cholesteatoma, the immunohistochemical reaction with the antibody against the LMP2 was positive, in both the cytoplasm of the cholesteatoma matrix and the perimatrix. A negative reaction with anti-LMP2 was observed in the cytoplasm and nuclei of control skin cells. A positive nuclear and cytoplasmic immunohistochemical reaction with anti-LMP7 has been demonstrated in numerous cells, in both the matrix and perimatrix of cholesteatoma. We present evidence of the presence of expressions of LMP2 and LMP7 within cholesteatoma tissue. Our results might bring new information concerning immunoproteasome-dependent pathophysiologic mechanisms in cholesteatoma.
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Affiliation(s)
- Justyna Rutkowska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
| | - Irena Kasacka
- Department of Histology and Cytophysiology, Medical University of Bialystok, 15-089 Białystok, Poland;
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-089 Białystok, Poland; (M.R.); (E.O.)
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Gao M, Xiao H, Liang Y, Cai H, Guo X, Lin J, Zhuang S, Xu J, Ye S. The Hyperproliferation Mechanism of Cholesteatoma Based on Proteomics: SNCA Promotes Autophagy-Mediated Cell Proliferation Through the PI3K/AKT/CyclinD1 Signaling Pathway. Mol Cell Proteomics 2023; 22:100628. [PMID: 37532176 PMCID: PMC10495652 DOI: 10.1016/j.mcpro.2023.100628] [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: 01/13/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/04/2023] Open
Abstract
Cholesteatoma is a chronic inflammatory ear disease with abnormal keratinized epithelium proliferation and tissue damage. However, the mechanism of keratinized epithelium hyperproliferation in cholesteatoma remains unknown. Hence, our study sought to shed light on mechanisms affecting the pathology and development of cholesteatoma, which could help develop adjunctive treatments. To investigate molecular changes in cholesteatoma pathogenesis, we analyzed clinical cholesteatoma specimens and paired ear canal skin with mass spectrometry-based proteomics and bioinformatics. From our screen, alpha-synuclein (SNCA) was overexpressed in middle ear cholesteatoma and might be a key hub protein associated with inflammation, proliferation, and autophagy in cholesteatoma. SNCA was more sensitive to lipopolysaccharide-induced inflammation, and autophagy marker increase was accompanied by autophagy activation in middle ear cholesteatoma tissues. Overexpression of SNCA activated autophagy and promoted cell proliferation and migration, especially under lipopolysaccharide inflammatory stimulation. Moreover, inhibiting autophagy impaired SNCA-mediated keratinocyte proliferation and corresponded with inhibition of the PI3K/AKT/CyclinD1 pathways. Also, 740Y-P, a PI3K activator reversed the suppression of autophagy and PI3K signaling by siATG5 in SNCA-overexpressing cells, which restored proliferative activity. Besides, knockdown of SNCA in RHEK-1 and HaCaT cells or knockdown of PI3K in RHEK-1 and HaCaT cells overexpressing SNCA both resulted in attenuated cell proliferation. Our studies indicated that SNCA overexpression in cholesteatoma might maintain the proliferative ability of cholesteatoma keratinocytes by promoting autophagy under inflammatory conditions. This suggests that dual inhibition of SNCA and autophagy may be a promising new target for treating cholesteatoma.
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Affiliation(s)
- Miao Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Heng Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yonglan Liang
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Huimin Cai
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaojing Guo
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianwei Lin
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Suling Zhuang
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Jianhua Xu
- Department of Pharmacology, School of Pharmacy, Fujian Provincial Key Laboratory of Natural Medicine Pharmacology, Fujian Medical University, Fuzhou, China.
| | - Shengnan Ye
- Department of Otorhinolaryngology Head and Neck Surgery, Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
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Neumann AS, Soyka MB, Rushing EJ, Röösli C. Gustatory Function of Patients With and Without Cholesteatoma Undergoing Middle Ear Surgery. Ann Otol Rhinol Laryngol 2023; 132:1068-1076. [PMID: 36285616 PMCID: PMC10359952 DOI: 10.1177/00034894221129911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To compare measured and perceived taste function before and after surgery of patients with chronic otitis media with cholesteatoma (OMCC) to patients without cholesteatoma (patients with chronic suppurative otitis media [CSOM] and patients with lateral skull base lesions [LSB]). METHODS This prospective cohort study included 29 patients undergoing surgery for unilateral OMCC. The chorda tympani nerve (CTN) was resected in 8 of these patients. Fourteen patients undergoing surgery for unilateral CSOM and 5 patients undergoing surgery for unilateral LSB (with CTN resection) served as the comparison group. Taste function was measured using taste strips on both sides of the tongue before surgery, 2 weeks postoperatively and 3 months postoperatively. The affected side of the tongue was compared to the unaffected side. A questionnaire on taste perception was completed at each visit. RESULTS Preoperatively, cholesteatoma patients showed higher taste strip scores than non-cholesteatoma patients, indicating a larger difference between the healthy and affected sides of the tongue. Despite this difference in measured taste function few cholesteatoma patients reported taste alteration before surgery (3/29 [10.3%]). Postoperatively, patients with CTN resection (OMCC patients with CTN resection and LSB patients) showed a decreased measured taste function. Subjectively, only approximately 20% of these patients reported taste alteration 3 months postoperatively. CONCLUSIONS Before surgery, cholesteatoma patients displayed an impaired measured taste function compared to patients without cholesteatoma (CSOM, LSB). Subjectively this was often unnoticed. After surgery, despite removal of the CTN and consequent reduction of measured taste function, few patients reported taste alteration and subjective taste perception was seen to be improving. In regards to middle ear surgery, perceived taste function does not seem to reflect measured gustatory function.
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Affiliation(s)
- Aline Sophie Neumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zürich, Switzerland
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Chan CY, Karmali SA, Arulanandam B, Nguyen LHP, Duval M. Cholesteatoma in Congenital Aural Atresia and External Auditory Canal Stenosis: A Systematic Review. Otolaryngol Head Neck Surg 2023; 169:449-453. [PMID: 35439089 DOI: 10.1177/01945998221094230] [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: 12/23/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with congenital external auditory canal (EAC) abnormalities are at risk of developing cholesteatoma and often undergo surveillance imaging to detect it. The aims of this systematic review are to determine the incidence of cholesteatoma in patients with congenital aural atresia (CAA) and patients with congenital EAC stenosis and to investigate the most common age of cholesteatoma diagnosis. This information will help clinicians decide which patients require surveillance scanning, as well as the timing of imaging. DATA SOURCES Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases. REVIEW METHODS A systematic literature review following the PRISMA guidelines was performed. The data sources were searched by 2 independent reviewers, and articles were included that reported on CAA or congenital EAC stenosis with a confirmed diagnosis of cholesteatoma. The selected articles were screened separately by 3 reviewers before reaching a consensus on the final articles to include. Data collection on the number of patients with cholesteatoma and the age of diagnosis was performed for these articles. RESULTS Eight articles met the inclusion criteria. The incidence of cholesteatoma was 1.7% (4/238) in CAA and 43.0% (203/473) in congenital EAC stenosis. The majority of patients with congenital EAC stenosis that developed cholesteatoma were diagnosed at age <12 years. CONCLUSION CAA is associated with a low risk of cholesteatoma formation, and surveillance imaging is unnecessary in asymptomatic patients. EAC stenosis is strongly associated with cholesteatoma, and a surveillance scan for these patients is recommended prior to 12 years of age with close follow-up into adulthood.
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Affiliation(s)
- Ching Yee Chan
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
| | | | - Brandon Arulanandam
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Institute of Health Sciences Education, McGill University, Montreal, Canada
- Department of Pediatric Surgery, McGill University, Montreal, Canada
| | - Melanie Duval
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal Children's Hospital, Montreal, Canada
- Department of Pediatric Surgery, McGill University, Montreal, Canada
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Lou Z. Acquired Cholesteatomas Behind Intact Tympanic Membranes of Adults: A Series of 13 Cases. Ear Nose Throat J 2023:1455613231193542. [PMID: 37596947 DOI: 10.1177/01455613231193542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Background and Objective: Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. Materials and Methods: The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). Results: A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. Conclusions: An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu city, Zhejiang provice, China
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Kapoor AA, Kapoor A, Nimkar NU, Soni HD, Ojha VS, Biswas R. High-Resolution Computed Tomography and Intraoperative Correlation in Cholesteatoma: Enhancing Preoperative Evaluation and Surgical Management. Cureus 2023; 15:e44333. [PMID: 37779786 PMCID: PMC10538802 DOI: 10.7759/cureus.44333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION Cholesteatoma, a hazardous non-neoplastic lesion of the temporal bone, is prevalent in socio-economically disadvantaged groups in developing nations like India. Timely detection and surgical intervention are essential for effective management. High-resolution computed tomography (HRCT) has revolutionized the assessment of temporal bone pathology, though its role in preoperative evaluation remains debated. This study aimed to validate HRCT's utility in diagnosing cholesteatoma, compare its findings with intraoperative observations, and assess sensitivity and specificity. METHODS This diagnostic accuracy study was conducted at a tertiary care center in Western India, from March 2021 to November 2022. HRCT findings of 54 cholesteatoma patients were evaluated and compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and Cohen's kappa coefficient were calculated. RESULTS HRCT demonstrated a sensitivity exceeding 90% in identifying scutum erosion, mastoid sclerosis, and abnormalities in the tympanic membrane, along with a specificity surpassing 90% in detecting various conditions, including facial canal erosion, sinus plate erosion, lateral semicircular canal erosion, erosion of the posterior wall of the external auditory canal, and abnormalities in the tympanic membrane. Furthermore, HRCT exhibited an accuracy of over 90% in detecting most pathologies. There was a perfect or near-perfect agreement observed for abnormal tympanic membrane, sinus plate erosion, mastoid sclerosis, and erosion of the posterior wall of the external auditory canal (with kappa values > 0.8). Moderate to fair agreement was noted for other pathologies. CONCLUSION HRCT offered precise detection of the majority of pathologies, thereby facilitating surgical planning. However, the presence of limitations in distinguishing specific abnormalities highlights the significance of utilizing HRCT in tandem with other diagnostic modalities to ensure meticulous diagnosis and effective treatment planning.
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Affiliation(s)
- Abha A Kapoor
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Abhay Kapoor
- Department of Internal Medicine, B.J. Medical College, Ahmedabad, Ahmedabad, IND
| | - Nimisha U Nimkar
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Hiren D Soni
- Department of Otorhinolaryngology, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Gotri, Vadodara, IND
| | - Vishnu S Ojha
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Ratnadeep Biswas
- Department of Internal Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
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Khairkar M, Deshmukh P, Maity H, Deotale V. Chronic Suppurative Otitis Media: A Comprehensive Review of Epidemiology, Pathogenesis, Microbiology, and Complications. Cureus 2023; 15:e43729. [PMID: 37727177 PMCID: PMC10505739 DOI: 10.7759/cureus.43729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Otitis media is a significant contributor to healthcare visits and the prescription of drugs. Its associated complications and consequences pose the primary factors for preventable hearing impairment, especially in developing nations. Chronic suppurative otitis media (CSOM) is prevalent among children globally as one of the commonest chronic infectious diseases during childhood. The subsequent complications and sequelae play a central role in causing avoidable hearing loss, particularly within developing countries. In addition to impaired hearing, this condition can lead to severe health complications, such as issues involving the intracranial region. Despite the involvement of microbial, immunological, and genetic factors as well as Eustachian tube characteristics, in the development of CSOM, there remains a need for further elucidation regarding its pathogenesis. Based on its microorganisms, the treatment of choice will be affected to prevent further complications in the child. The primary approach to treating acute otitis media (AOM) involves effectively addressing ear pain and fever symptoms, while antibiotics are only administered in cases where children experience severe, long-lasting, or frequent infections. Despite the extensive investigation on AOM pathogenesis, research is scarce regarding CSOM. Given that antibiotic resistance and drug-induced ear damage are growing problems and surgery-related complications, it is imperative to devise effective therapeutic interventions against CSOM arises. Therefore, comprehending the host's immune function concerning CSOM and identifying how bacteria sidestep these potent responses becomes crucial. Acquiring insight into molecular mechanisms associated with CSOM will enable scientists to formulate innovative treatment approaches to combat this disease, thereby averting hearing loss consequences. The management consists of watchful waiting, primarily for children with chronic effusions and hearing loss.
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Affiliation(s)
- Mihika Khairkar
- Department of Otolaryngology, Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Department of Otolaryngology, Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hindol Maity
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, IND
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, IND
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Kara H, Sen C, Sonmez S, Celik M, Polat B. The effect of bony obliteration on quality of life after tympano-mastoidectomy surgery: A prospective observational controlled cohort study. Laryngoscope Investig Otolaryngol 2023; 8:1052-1060. [PMID: 37621278 PMCID: PMC10446264 DOI: 10.1002/lio2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. Methods A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. Results The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). Conclusion There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. Level of Evidence 1b (individual prospective cohort study).
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Affiliation(s)
- Hakan Kara
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Comert Sen
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Said Sonmez
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Mehmet Celik
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
| | - Beldan Polat
- Istanbul Faculty of Medicine, Department of Otorhinolaryngology and Head and Neck SurgeryIstanbul UniversityIstanbulTurkey
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Dżaman K, Czerwaty K, Reichert TE, Szczepański MJ, Ludwig N. Expression and Regulatory Mechanisms of MicroRNA in Cholesteatoma: A Systematic Review. Int J Mol Sci 2023; 24:12277. [PMID: 37569652 PMCID: PMC10418341 DOI: 10.3390/ijms241512277] [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: 07/08/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Cholesteatoma is a temporal bone disease characterized by dysfunctions of keratinocytes. MicroRNAs (miRNAs) are evolutionary conserved noncoding RNAs that regulate mRNA expression. They can be packaged into exosomes and transported to target cells that can be used in the future therapy of cholesteatoma. This study aimed to collect knowledge on the role of miRNAs and exosomal miRNAs in cholesteatoma and was conducted according to the PRISMA guidelines for systematic reviews. Four databases were screened: Pubmed/MEDLINE, Web of Science, Scopus, and the Cochrane Library. The last search was run on the 6th of June 2023. We included full-text original studies written in English, which examined miRNAs in cholesteatoma. The risk of bias was assessed using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool, modified for the needs of this review. We identified 118 records and included 18 articles. Analyses revealed the downregulation of exosomal miR-17 as well as miR-10a-5p, miR-125b, miR-142-5p, miR34a, miR-203a, and miR-152-5p and the overexpression of exosomal miR-106b-5p as well as miR-1297, miR-26a-5p, miR-199a, miR-508-3p, miR-21-3p, miR-584-5p, and miR-16-1-3p in cholesteatoma. The role of differentially expressed miRNAs in cholesteatoma, including cell proliferation, apoptosis, the cell cycle, differentiation, bone resorption, and the remodeling process, was confirmed, making them a potential therapeutic target in this disease.
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Affiliation(s)
- Karolina Dżaman
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
| | - Katarzyna Czerwaty
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
| | - Torsten E. Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
| | - Mirosław J. Szczepański
- Department of Otolaryngology, The Medical Centre of Postgraduate Education, 01-813 Warsaw, Poland; (K.D.); (K.C.)
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Nils Ludwig
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (T.E.R.); (N.L.)
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Pietraszek M, Bartochowska A, Wierzbicka M, Gawęcki W. The assesment of intraoperative use of mesna in canal wall-up cholesteatoma surgery - preliminary report. Otolaryngol Pol 2023; 77:1-6. [PMID: 37772375 DOI: 10.5604/01.3001.0016.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
<b>Introduction:</b> Surgery is still the method of choice in chronic otitis media with cholesteatoma. Except for some specific clinical situations, classic canal wall up technique (CWU), remains a gold standard as a primary treatment in most departments. Unfortunately, the risk of recurrence in such an approach is estimated at 9 to even 70%. This fact prompts researchers to look for ways to reduce those unfavourable statistics. One of the recognized methods supporting the removal of cholesteatoma is the intraoperative use of mesna (sodium 2-mercaptoethanesulfonate). This synthetic sulphur compound disrupts disulfide bridges in polypeptide chains, thanks to which it facilitates matrix preparation.</br></br> <b>Aim:</b> To evaluate the effect of intraoperative use of mesna on the treatment outcomes in patients with chronic otitis media with cholesteatoma operated on by means of the canal wall up technique (CWU).</br></br> <b>Material and methods:</b> 459 surgical reports of patients with middle ear cholesteatoma were analyzed. In total, 52 adult patients with no history of previous ear surgery operated on by means of the CWU technique by the same experienced otosurgeon with all follow-up data available were included in the study. Twenty-six were operated on with the use of mesna (mesna group) and 26 by means of the classic CWU technique (control / no-mesna group). There were 28 women and 24 men with a mean age of 41 years.</br></br> <b>Main Outcome Measure(s):</b> Postoperative hearing results and cholesteatoma recidivism rate.</br></br> <b>Results:</b> Overall recidivism rate was 21.15 %. It was higher in the no-mesna (26.9%) than in the mesna group (15.4%) - although the outcomes were better in the mesna group, the difference was not statistically significant (P = 0.49715). Hearing gain was better in the mesna than in the no-mesna group (10 dB vs 7 dB), but the difference was not statistically significant (P = 0.20089).</br></br> <b>Conclusions:</b> Our preliminary results show that mesna reduces recidivism rates in patients with cholesteatoma. Further study with the analysis of a larger group of patients is needed to prove it statistically.
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Affiliation(s)
- Marta Pietraszek
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poland
| | - Anna Bartochowska
- Department of Otolaryngology and Laryngological Oncology, Medical University of Poznan, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, Poznan, Poland
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Eroğlu O, Eroğlu Y, Yıldırım M, Karlıdag T, Çınar A, Akyiğit A, Kaygusuz İ, Yıldırım H, Keleş E, Yalçın Ş. Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma. J Int Adv Otol 2023; 19:342-349. [PMID: 36999593 PMCID: PMC10544284 DOI: 10.5152/iao.2023.221004] [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: 11/29/2023] [Accepted: 02/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma. METHODS The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared. RESULTS Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%. CONCLUSION In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.
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Affiliation(s)
- Orkun Eroğlu
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Yeşim Eroğlu
- Department of Radiology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Muhammed Yıldırım
- Department of Computer Engineering, Malatya Turgut Özal University, Faculty of Engineering and Natural Sciences, Malatya, Turkey
| | - Turgut Karlıdag
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Ahmet Çınar
- Department of Computer Engineering, Fırat University, School of Engineering, Elazığ, Turkey
| | - Abdulvahap Akyiğit
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
| | - İrfan Kaygusuz
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Hanefi Yıldırım
- Department of Radiology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Erol Keleş
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
| | - Şinasi Yalçın
- Department of Otorhinolaryngology, Fırat University, School of Medicine, Elazığ, Turkey
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Kishan Siddapur G, Gangwar N, Coimbatore Balakrishnan M, Murugesan V. Clinical Study of Labyrinthine Fistula in Cholesteatomatous Chronic Otitis Media: A Tertiary Care Hospital-Based Retrospective Study in a South Indian Population. Cureus 2023; 15:e42413. [PMID: 37637549 PMCID: PMC10448227 DOI: 10.7759/cureus.42413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Among the extracranial complications of cholesteatoma, the most common is labyrinthine fistula (LF). The causes are still poorly understood for cholesteatoma-induced labyrinthine fistula. Some of the possible factors described in the literature are the patient's age, duration of the disease, growth pattern of cholesteatoma, and disease aggressiveness. These affect the site of development of labyrinthine fistula. Cholesteatoma and its complications pose a great burden on the economic and health sector of developing nations. AIM AND OBJECTIVE The objective is to estimate the incidence of labyrinthine fistula in cholesteatomatous chronic otitis media (COM) and analyze the clinical presentation and post-surgical improvement in hearing and vertigo in the study cohort. MATERIALS AND METHOD The study was conducted in the Department of Otorhinolaryngology. It involved retrospective data collection of case records between 2018 and 2022. All patients diagnosed with chronic otitis media (COM) with cholesteatoma were reviewed retrospectively in a tertiary healthcare center. Of the 324 cases reviewed, 21 had an LF. RESULTS The incidence rate of LF in our study was 6.48%. Sixteen (76.1%) patients were male, and five (23.9%) were female. The youngest patient was a 10-year-old male, and the oldest was a 51-year-old female. The mean ± standard deviation (SD) age was 34.09 ± 10.05 years. The left ear (76.1%) was affected more than the right ear. All cases were from rural areas, and 16 (76.1%) of them were farmers. Ear discharge (85%) was the most common symptom, followed by hearing loss (76%) and then vertigo (47%). A very peculiar risk factor of self-cleansing the ear was noticed in all patients. Out of the 21 patients who underwent surgery, it was observed that the lateral semicircular canal (LSCC) was the commonest site of the fistula. According to the Dornhoffer and Milewski classification, type II LF was the commonest type. In one patient with a type III LF, a foreign body (a piece of a twig) was found intraoperatively near the LSCC fistula site. Two patients had multiple fistulae. Six patients had associated mastocutaneous fistula, and one had facial nerve paralysis. All patients, except one, were free of vertigo following surgery. Postoperatively, the bone conduction thresholds were similar to the pre-surgical values in 12 of 16 (74%) patients. CONCLUSION The incidence of LF is still higher in developing countries, predominantly in rural populations, where the habit of self-cleansing the ear is a common practice. The common symptoms of COM with LF are ear discharge, hearing impairment, and vertigo. All the cases had a habit of frequent self-cleansing of the external ear as an important risk factor. Therefore, implementing awareness programs on maintaining aural hygiene in rural health centers may reduce the incidence of cholesteatomatous LF, thereby preserving hearing and vestibular functions and improving the quality of life. However, the above statement needs further validation with large multicenter studies.
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Affiliation(s)
- Geetha Kishan Siddapur
- Otolaryngology - Head and Neck Surgery, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, IND
| | - Navneeta Gangwar
- Otolaryngology - Head and Neck Surgery, Jaipur National University Institute of Medical Sciences and Research Centre, Jaipur, IND
| | | | - Vandhana Murugesan
- Otolaryngology - Head and Neck Surgery, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, IND
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Mishael T, Philip B, George A, S S. Co-existing Paraganglioma, Cholesteatoma, and Otomastoiditis With Overlapping Imaging Features: A Diagnostic Challenge. Cureus 2023; 15:e42373. [PMID: 37621839 PMCID: PMC10445775 DOI: 10.7759/cureus.42373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Head and neck paragangliomas are rare neuroendocrine tumors arising from the autonomic nervous system. Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity on computed tomography; a salt-and-pepper appearance on standard spin-echo magnetic resonance imaging; and an intense blush on angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and predict operative morbidity and mortality. However, an atypical presentation of paragangliomas, especially when co-existing with other middle ear pathologies that have overlapping imaging findings, can often be misleading. Here, we report a case of simultaneous occurrence of paraganglioma, cholesteatoma, and otomastoiditis in a young adult female.
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Affiliation(s)
- Tom Mishael
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Babu Philip
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Arun George
- Radiology, St. John's Medical College Hospital, Bangalore, IND
| | - Sandeep S
- Radiology, St. John's Medical College Hospital, Bangalore, IND
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Heo KW, Noh M, Hur DY, Hong TU, Park SY, Kim WJ. Bone destruction in chronic otitis media is not mediated by the RANKL pathway or estrogen receptor-alpha. Sci Prog 2023; 106:368504231199204. [PMID: 37697808 PMCID: PMC10498706 DOI: 10.1177/00368504231199204] [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] [Indexed: 09/13/2023]
Abstract
BACKGROUND Chronic otitis media with or without cholesteatoma progresses with various degrees of bone resorption and remodeling. Estrogen mediates osteoprotective effects through the receptor activator of NF-κB ligand (RANKL) pathway, which is mainly mediated by estrogen receptor-alpha (ER-α). OBJECTIVES The present study investigated the expression patterns of receptor activator of NF-κB (RANK), osteoprotegerin (OPG), RANKL, and ER-α in pathological tissue from patients with chronic otitis media to determine the roles of those factors in osteolytic mechanisms underlying the pathogenesis of chronic otitis media. METHODS Normal and pathological specimens from 18 patients with chronic otitis media were examined. RESULTS There were no significant differences in RANK, OPG, RANKL, or ER-α mRNA expression between normal and pathological specimens of epithelial tissue. CONCLUSIONS Our findings suggested that RANK, OPG, RANKL, and ER-α are not associated with the bone destruction in chronic otitis media; other cytokines may directly activate the osteoclasts in chronic otitis media.
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Affiliation(s)
- Kyung Wook Heo
- Department of Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Busan, South Korea
| | - MinHye Noh
- Anatomy and Research Center for Tumor Immunology Inje University College of Medicine, Busan Paik Hospital, Busan, South Korea
| | - Dae Young Hur
- Anatomy and Research Center for Tumor Immunology Inje University College of Medicine, Busan Paik Hospital, Busan, South Korea
| | - Tae Ui Hong
- Department of Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Busan, South Korea
| | - Sung Yool Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Busan, South Korea
| | - Woo Jin Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Busan Paik Hospital, Busan, South Korea
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