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Laryngoscope Investigative... Feb 2022To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia.
OBJECTIVE
To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia.
STUDY DESIGN
Cross-sectional population-based study using data from the National Hospital Morbidity Database.
METHODS
Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods.
RESULTS
Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2-9.0) and 8.1 per 100,000 (95% CI: 7.7-8.5) for 2017-2018 and 2007-2008, respectively. Population aged 10-19 years had the highest age-specific incidence rate at 12.5 per 100,000 (95% CI: 11.3-13.9) for 2017-2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41-1.86], <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61-0.78], <.001]).
CONCLUSIONS
The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. 4.
PubMed: 35155800
DOI: 10.1002/lio2.709 -
Cureus Oct 2021Our objective is to analyze the risk of particle spread through mastoidectomy during the COVID-19 pandemic with an aim to assess the tools used to mitigate the... (Review)
Review
Our objective is to analyze the risk of particle spread through mastoidectomy during the COVID-19 pandemic with an aim to assess the tools used to mitigate the spread. A systematic review was conducted using PRISMA guidelines. Our search terms included: MASTOIDECTOMY + COVID-19 or MASTOIDECTOMY + SAR- CoV-2 or MASTOIDECTOMY + CORONAVIRUS. Studies consistent with the inclusion and exclusion criteria were included in the review. Of the 20 articles identified in the initial search, six met the inclusion criteria. The included articles were all experimental studies, with five studies using cadaver subjects and one study using live human subjects. Three studies measured droplet spread and three studies measured aerosolized particle spread. The maximum distance of particle spread ranged from 30 cm to 208 cm. Four studies assessed the use of a barrier system, with two using the OtoTent and two using a barrier drape. Two studies defined the microscope alone as a possible mitigatory tool. One study compared burr type and size to determine the effects on particle spread. During the coronavirus disease 2019 (COVID-19) pandemic, evaluation of tools to mitigate particle spread is imperative for the safety of the surgical team and the healthcare system at large. Barrier drapes, OtoTents and microscopes all have proven to mitigate particle spread; however, further research needs to be performed to compare their efficacy and develop a standard of safety.
PubMed: 34853757
DOI: 10.7759/cureus.19040 -
Indian Journal of Otolaryngology and... Apr 2023Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless...
UNLABELLED
Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless surgical field and good postoperative outcome and results. The application of Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet are presented. This innovation will provide limited and adequate bone removal in a faster way than drill in endoscopic mastoidectomy and stapedotomy surgeries. Surgical instruments represent a major financial asset to the health care facilities. The use of Dr Ahila's Endoscopic Ear Surgery straight 1 mm or 2 mm Chisel and Mallet is presented. Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet, this innovation will provide faster bone removal than drill or curette without bone dust formation, fogging, irrigation in Endoscopic mastoidectomy and stapedotomy. This instrument is essential to avoid costly replacement, surgeon satisfaction, reduce cost and delays in the operating room and in safe and trained hands enhance patient safety.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-023-03629-0.
PubMed: 37200899
DOI: 10.1007/s12070-023-03629-0 -
Indian Journal of Otolaryngology and... Sep 2023To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of...
AIMS
To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of previous surgery to minimize the Revision surgery.
MATERIALS AND METHODS
This was a prospective and retrospective observational study conducted at a tertiary care hospital from May 2019 to December 2021. Total 20 Patients (11 male & 9 female) with age group (0-60 years) who previously underwent canal wall down mastoidectomy and presented with complaints of persistent ear discharge were included. All patients underwent otoscopic, oto-endoscopic and microscopic examination.
RESULTS
Out of 20 cases,13 cases had residual/recurrent cholesteatoma, 11 cases had narrow meatoplasty and 9 cases had high facial ridge.Other causes for failure are graft defect, incomplete removal of anterior and posterior buttress.
CONCLUSION
Recurrent/residual cholesteatoma and Narrow meatoplasty are most common cause for failure of previous surgery. Persistent granulation at un-exenterated area was the most common cause for suppuration. Regular follow up and cleaning of the debris from cavity enhances the epithelialization and healing of the cavity.
PubMed: 37636609
DOI: 10.1007/s12070-023-03704-6 -
Otology & Neurotology : Official... Apr 2024The operating microscope (OM) commonly used in ear surgeries has several disadvantages, including a low depth of field, a narrow field of view, and unfavorable ergonomic... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
The operating microscope (OM) commonly used in ear surgeries has several disadvantages, including a low depth of field, a narrow field of view, and unfavorable ergonomic characteristics. The exoscope (EX) was developed to overcome these disadvantages. Herein, we compared OM and EX during mastoidectomy and found out the feasibility of the EX.
STUDY DESIGN
Prospective randomized comparative study.
SETTING
Tertiary academic medical center.
PATIENTS
Patients who had mastoidectomy for chronic otitis media with or without cholesteatoma between January 2022 and April 2022.
INTERVENTION
Canal wall-up mastoidectomy (CWUM) or canal wall-down mastoidectomy (CWDM) using OM or EX without endoscope.
MAIN OUTCOME MEASURES
Operative setting time (the time between the end of general anesthesia and incision), operative time (from incision to suture), postoperative audiologic outcomes, perioperative complications, and the decision to switch from EX to OM.
RESULTS
Of 24 patients who were diagnosed with chronic otitis media or cholesteatoma, 12 each were randomly assigned to the OM or EX group. The mean operation time was 175 ± 26.5 minutes and 172 ± 34.6 minutes in the EX and OM group, respectively, which was not significantly different ( p = 0.843). The procedures in the EX group were successfully completed using a three-dimensional (3D)-EX without conversion to OM. All surgeries were completed without any complications. The postoperative difference in the air and bone conduction was 11.2 and 12.4 dB in the EX and OM groups, respectively, which was not significantly different ( p = 0.551).
CONCLUSIONS
EX is comparable to OM in terms of surgical time, complications, and audiologic outcomes following mastoidectomy. The EX system is a potential alternative to OM. However, further improvements are required to overcome some drawbacks (deterioration of image resolution at high magnification, requirement of an additional controller for refocusing).
Topics: Humans; Cholesteatoma, Middle Ear; Chronic Disease; Mastoid; Mastoidectomy; Otitis Media; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 38437812
DOI: 10.1097/MAO.0000000000004138 -
Otolaryngologia Polska = the Polish... Dec 2022ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial...
ntroductionIn all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in presence of facial canal dehiscence (FCD).AimIn this study, we aimed to evaluate the FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy.Materials and Methods850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, localization of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery was evaluated. ResultsFacial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (p<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (p<0.03). In revision cases, dehiscence was seen more frequently (p<0.003). FCD incidence was higher in adult patients than in pediatric patients (p<0.001). Twenty of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. ConclusionFacial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications.Keywords: Cholesteatoma, tympanic, radical mastoidectomy, oval window, tympanomastoidectomy.
Topics: Adult; Child; Humans; Cholesteatoma; Chronic Disease; Ear, Middle; Otitis Media; Mastoidectomy
PubMed: 36805516
DOI: 10.5604/01.3001.0016.1772 -
Medicina (Kaunas, Lithuania) Jun 2023: Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial.
: Postoperative nausea and vomiting (PONV) is a common adverse effect of general anesthesia, especially in middle ear surgery. Remimazolam is a newer benzodiazepine recently approved for use in general anesthesia. This study aimed to compare the incidence rate of PONV after tympanoplasty with mastoidectomy between using remimazolam and sevoflurane. : This study included 80 patients undergoing elective tympanoplasty with mastoidectomy. The patients were randomly assigned to either the remimazolam or sevoflurane group. The primary outcome was the incidence rate of PONV 12 h after surgery. The secondary outcomes were the incidence rate of PONV 12-24 and 24-48 h after surgery, severity of PONV, incidence rate of vomiting, administration of rescue antiemetics, hemodynamic stability, and recovery profiles. : The incidence rate of PONV 0-12 h after tympanoplasty with mastoidectomy was significantly lower in the remimazolam group compared with that in the sevoflurane group (28.9 vs. 57.9%; = 0.011). However, the incidence rate of delayed PONV did not differ between the two groups. PONV severity in the early periods after the surgery was significantly lower in the remimazolam group than in the sevoflurane group. The incidence rate of adverse hemodynamic events was lower in the remimazolam group than in the sevoflurane group, but there was no difference in the overall trends of hemodynamic data between the two groups. There was no difference in recovery profiles between the two groups. : Remimazolam can significantly reduce the incidence rate of early PONV after tympanoplasty with mastoidectomy under general anesthesia.
Topics: Humans; Postoperative Nausea and Vomiting; Sevoflurane; Incidence; Tympanoplasty; Mastoidectomy; Benzodiazepines; Double-Blind Method
PubMed: 37512009
DOI: 10.3390/medicina59071197 -
Clinical Otolaryngology : Official... May 2021The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the...
OBJECTIVES
The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the adequacy of PPE in such procedures.
DESIGN AND SETTING
Mastoid surgery was simulated in a dry laboratory using a plastic temporal bone, microscope and handheld drill with irrigation and suction. Comparisons of distance of droplet and bone dust contamination and surgeon contamination were made under differing conditions. Irrigation speed, use of microscope and drill burr size and type were compared.
MAIN OUTCOME MEASURES
Measurement of the distance of field contamination while performing simulated mastoidectomy and location of surgeon contamination.
RESULTS
There was a greater distance field contamination and surgeon contamination without the use of the microscope. Contamination was reduced by using a smaller drill burr and by using a diamond burr when compared to a cutting burr. The use of goggles and a face mask provided good protection for the surgeon. However, the microscope alone may provide sufficient protection to negate the need for goggles.
CONCLUSIONS
While the risks of performing mastoid surgery during the coronavirus pandemic cannot be completely removed, they can be mitigated. Such factors include using the microscope for all drilling, using smaller size drill burrs and creating a safe zone around the operating table.
Topics: COVID-19; Dust; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Mastoidectomy; Models, Anatomic; Personal Protective Equipment; Suction; Therapeutic Irrigation
PubMed: 33533176
DOI: 10.1111/coa.13725 -
Acta Otorrinolaringologica Espanola May 2021The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of...
INTRODUCTION AND OBJECTIVE
The treatment of cholesteatoma is surgical in most cases. When it is indicated, it is preferable to choose a reconstructive surgical technique with the dual purpose of eradicating the disease and preserving or improving the patient's hearing. In 2017, the European Academy of Otology and Neuro-Otology/Japanese Otological Society (EAONO/JOS) published a new cholesteatoma classification. The aims of this study are to determine the influence of the surgical technique use and this classification on patient's hearing outcomes.
METHODS
A retrospective study that include patients who underwent reconstructive surgery of cholesteatoma between 2012 and 2017 is carried out. Based on pre-surgical computed tomography (CT) images, disease is staged according to the EAONO/JOS classification. Hearing outcomes obtained by pre and postoperative pure tone audiometry are analysed according to the surgical technique used and according to the stage of the disease.
RESULTS
143 patients with no statistically significant differences in hearing thresholds before surgery are included. One year after surgery, all the patients' airbone pure tone average (PTA) and mean differential auditory threshold have improved significantly (P = .01 and P = .001). Those patients who undergo tympanoplasty with two-stage canal wall up mastoidectomy presente better postsurgical air PTA and postsurgical mean differential auditory threshold outcomes (P=.007 and P=.014) than those patients who underwent tympanoplasty with canal wall down mastoidectomy. Moreover, the patients who underwent tympanoplasty with two-stage canal wall up mastoidectomy had improved airbone PTA and mean differential auditory threshold one year after the surgery with statistical significance (P=.001 and P=.013). The mean differential auditory threshold is also better (P=.008) in the patients who undergo tympanoplasty with canal wall down mastoidectomy one year after the procedure.
CONCLUSIONS
Reconstructive surgical techniques improve hearing one year after surgery. In our study, this improvement is significantly greater with tympanoplasty with two-stage canal wall up mastoidectomy.
PubMed: 34082923
DOI: 10.1016/j.otorri.2021.02.006 -
The Medical Journal of Malaysia Aug 2021Similar to other surgical fraternities, endoscopic ear surgery (EES) faced great challenges during the COVID-19 pandemic. Many elective operations involving EES needed...
Similar to other surgical fraternities, endoscopic ear surgery (EES) faced great challenges during the COVID-19 pandemic. Many elective operations involving EES needed to be postponed, resulting in accumulated cases. Throughout one year during COVID-19, Hospital Sultan Ismail, Johor, Malaysia continued to perform various EES procedures. Although EES is an aerosol-generating procedure, it has become evidence that this minimallyinvasive surgical approach offers lesser bony drilling and shorter operative time as compared to open mastoidectomy. Thus, this reduced the risk of viral transmission to the surgeons and operating staffs.
Topics: COVID-19; Humans; Mastoidectomy; Otologic Surgical Procedures; Pandemics; SARS-CoV-2
PubMed: 34558558
DOI: No ID Found