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Harefuah May 2021Cholesteatoma is the most severe middle ear disease. In most cases cholesteatoma results from under-aeration of the middle ear cleft. It is characterized by otorrhea and... (Review)
Review
Cholesteatoma is the most severe middle ear disease. In most cases cholesteatoma results from under-aeration of the middle ear cleft. It is characterized by otorrhea and hearing loss, and may lead to severe complications, intra- and extra-cranial. There is no non-surgical treatment for cholesteatoma. Surgical treatment is the only option. Cholesteatoma is diagnosed by micro-otoscopy. When cholesteatoma is suspected and otoscopy is inconclusive, imaging is mandatory. The goal of treatment in cholesteatoma is to achieve a stable and safe ear. In most cases, upon diagnosis, cholesteatoma is quite extensive and mastoidectomy is needed. Choice of surgery [Canal wall up mastoidectomy with tympanoplasty (the more conservative alternative), Canal wall down (radical) mastoidectomy with meatoplasty or Canal wall down (radical) mastoidectomy with reconstruction of external ear canal, tympanoplasty and mastoid obliteration], depends on the extent of the disease, the anatomic relationship between the sensitive structures that protrude into the walls of middle ear and mastoid cavities and the bony destruction that had already been caused by the disease. Hearing rehabilitation should lead to a stable, predictable, symmetric and as close as possible to normal hearing threshold. In many cases the solution is external or implantable hearing devices. Cholesteatoma has a high recidivism rate that leads to repeated surgery. In order to diagnose and treat cholesteatoma recidivism, a structured follow-up is needed after cholesteatoma surgery, with periodical otoscopy (every 6-12 months) and MRI (every 1-2 years). When cholesteatoma recidivism is diagnosed, surgery is indicated before the disease grows and becomes infected.
Topics: Cholesteatoma, Middle Ear; Humans; Mastoid; Mastoidectomy; Retrospective Studies; Treatment Outcome
PubMed: 34028225
DOI: No ID Found -
Laryngo- Rhino- Otologie Jul 2023
Topics: Humans; Mastoidectomy; Cholesteatoma
PubMed: 37399816
DOI: 10.1055/a-1987-2064 -
Hearing Research Jun 2022In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC... (Review)
Review
In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC hearing sensitivity occurs when sound travels to the contralateral cochlea as compared to the ipsilateral cochlea. This effect is called transcranial attenuation (TA) that is affected by several factors. Experimental and clinical studies describe TA and the factors that have an effect on it. These factors include stimulus location, coupling of a bone conduction hearing aid to the underlying tissue, and the properties of the head (such as geometry of the head, thickness of the skin and/or skull, changes due to aging, iatrogenic changes such as bone removal in mastoidectomy, and occlusion of the external auditory canal). While TA has an effect of the patient's benefit of BCHAs, there seems to be a discrepancy between experimental measurements and clinical relevance. The effects are small and the interindividual variability, in comparison, is rather large. However, a better understanding of these factors may help to determine the site of attachment, the coupling mode, and possibly the fitting of a BCHA, depending on its indication.
Topics: Acoustic Stimulation; Bone Conduction; Cochlea; Hearing Aids; Humans; Mastoidectomy; Sound; Vibration
PubMed: 34334219
DOI: 10.1016/j.heares.2021.108318 -
Otolaryngologic Clinics of North America Dec 2020Robots under research and development for otology can be classified as collaborative (intervention is constrained by the robot but surgeon directly actuates the... (Review)
Review
Robots under research and development for otology can be classified as collaborative (intervention is constrained by the robot but surgeon directly actuates the end-effector), teleoperated (surgeon remotely controls a tool with modification [eg, tremor reduction] by the robot), or autonomous (surgeon monitors the robot performing a task). Current clinical trials focus on more accurate stapes surgery, minimally invasive access to the cochlea, and less traumatic insertion of cochlear implant electrode arrays. Autonomous approaches to major aspects of surgical interventions (eg, mastoidectomy) will likely be late entries to clinical use, given higher cost of regulatory approval and disruption of existing workflow.
Topics: Cochlea; Cochlear Implantation; Humans; Minimally Invasive Surgical Procedures; Robotic Surgical Procedures; Stapes Surgery
PubMed: 33127040
DOI: 10.1016/j.otc.2020.07.014 -
The Turkish Journal of Pediatrics 2023Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus... (Review)
Review
BACKGROUND
Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature.
METHODS
We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`.
RESULTS
We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%.
CONCLUSIONS
Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community.
Topics: Humans; Child; Mastoiditis; Abscess; Anti-Bacterial Agents; Conservative Treatment
PubMed: 38204305
DOI: 10.24953/turkjped.2023.320 -
The Journal of International Advanced... Jan 2021To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of...
OBJECTIVES
To describe the clinical course and outcome of a group of adults who presented with a subperiosteal abscess (SPA) MATERIALS and METHODS: A retrospective chart review of patients with SPA.
RESULTS
Between 2001 and 2015, 7 such patients-5 men and 2 women-were identified. Their age ranged from 18 to 62 years. Six of them suffered from chronic otitis media (COM) and presented with signs and symptoms of otalgia, pain, and swelling around the mastoid. Five of the patients underwent a previous mastoidectomy for cholesteatoma (4- canal wall down and 1 had canal wall up). One of the non-operated patients had cholesteatoma and the other one had chronic suppurative otitis media without cholesteatoma. One patient developed peripheral facial nerve palsy that resolved after surgery, otherwise, no other intratemporal or intracranial complications were observed. Management included a canal wall down mastoidectomy, abscess drainage, and parenteral wide-spectrum antibiotics. One patient suffered cardiovascular and respiratory comorbidities, requiring the delay of surgery for 6 days. This patient underwent incision and drainage of the abscess before surgery. Pathogens were recognized in 4 of the patients and included Streptococcus pneumoniae, Candida albicans, Staphylococcus aureus, and Corynebacterium.
CONCLUSION
SPA in adults is rare but may be seen in cases of neglected COM, whether previously operated or not. Comorbidities in older population group may require postponing surgery, so immediate incision and drainage may be warranted, as well as post-surgical intensive care.
Topics: Abscess; Adolescent; Adult; Cholesteatoma, Middle Ear; Female; Humans; Male; Mastoid; Middle Aged; Otitis Media; Otitis Media, Suppurative; Retrospective Studies; Young Adult
PubMed: 33605218
DOI: 10.5152/iao.2020.8432 -
Neuroimaging Clinics of North America Feb 2022Evaluation of the postoperative temporal bone can be difficult given the complex anatomy of this region and the myriad surgical approaches for management of a variety of... (Review)
Review
Evaluation of the postoperative temporal bone can be difficult given the complex anatomy of this region and the myriad surgical approaches for management of a variety of conditions. This article provides an understanding of common postsurgical changes of the temporal bone and their typical imaging appearances. Ultimately, greater radiologist knowledge of postoperative temporal bone imaging findings will help to serve patients and referring clinicians with prompt diagnosis and recognition of expected postintervention changes compared with postoperative complications and/or disease recurrence.
Topics: Humans; Postoperative Complications; Temporal Bone; Tomography, X-Ray Computed
PubMed: 34809837
DOI: 10.1016/j.nic.2021.08.006 -
European Archives of... Aug 2023It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different...
PURPOSE
It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case.
CASE PRESENTATION
A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy.
CONCLUSIONS
Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.
Topics: Female; Humans; Adult; Mastoidectomy; Retrospective Studies; Mastoid; Ear, Middle; Ear Diseases; Ear Canal; Cholesteatoma, Middle Ear
PubMed: 37195344
DOI: 10.1007/s00405-023-08021-w -
Indian Journal of Otolaryngology and... Aug 2022Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality...
Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.
PubMed: 36032880
DOI: 10.1007/s12070-020-02042-1