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Acta Otorrinolaringologica Espanola 2023To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD).
AIMS
To evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD).
MATERIAL AND METHODS
A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12.
RESULTS
The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire.
CONCLUSIONS
Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery.
Topics: Humans; Mastoidectomy; Quality of Life; Mastoid; Retrospective Studies; Cholesteatoma, Middle Ear
PubMed: 37331626
DOI: 10.1016/j.otoeng.2023.06.004 -
South African Journal of Surgery.... Mar 2022Tuberculosis (TB) otitis media is an uncommon site of extrapulmonary TB and can primarily present as a complicated TB mastoiditis (TBM). This complication is rare in...
BACKGROUND
Tuberculosis (TB) otitis media is an uncommon site of extrapulmonary TB and can primarily present as a complicated TB mastoiditis (TBM). This complication is rare in children, even in TB endemic areas but necessitates early identification as delays can lead to severe morbidities. We describe the clinical characteristics as a case series to raise awareness of the condition, and highlight fundamentals related to diagnosis and management.
METHODS
A retrospective chart review of clinical and radiological information of five children with TBM seen at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa, over the last 5 years. Variables collected included symptomatology, duration of disease, investigations and management.
RESULTS
All were under 5 years of age and presented with typical features of acute bacterial mastoiditis. Mean duration of symptoms was 12 days (range 3-30 days). Two children had known TB contacts. Two children had pulmonary involvement, one with miliary TB. CT of the temporal bone demonstrated extensive bony destruction of the petromastoid and demineralised ossicles in all cases. Three children had intracranial extension. Four children demonstrated hearing loss between 30 dB and 83 dB. Necrotising granulomatous inflammation was present in the mastoid specimens in all cases. Confirmatory diagnosis was made via GeneXpert polymerase chain reaction (PCR) (2), Ziehl-Nielson (ZN) stain (1) or a positive TB culture (2). Postoperatively, one patient had normal hearing, two patients had mild conductive hearing loss (CHL), one had mild-moderate CHL and one had profound hearing loss.
CONCLUSION
Delays in identification and management result in marked bony destruction and hearing loss. Radiological and surgical findings typical of TBM, therefore, require tissue sampling from the ear for urgent microscopic, PCR and histologic testing, allowing the avoidance of a mastoidectom. In a TB endemic setting, children with typical findings and necrotising granulomatous inflammation on histology should be considered for prompt commencement of anti-TB therapy while awaiting a definitive diagnosis.
Topics: Child; Hearing Loss; Humans; Inflammation; Mastoid; Mastoiditis; Retrospective Studies; South Africa; Tuberculosis
PubMed: 35451273
DOI: No ID Found -
Otology & Neurotology : Official... Oct 2022We report a novel postmastoidectomy hyperacusis syndrome (PMHS) in patients who have had cortical mastoidectomies and experience hyperacusis to stimuli involving touch...
OBJECTIVE
We report a novel postmastoidectomy hyperacusis syndrome (PMHS) in patients who have had cortical mastoidectomies and experience hyperacusis to stimuli involving touch of the pinna and periauricular area. This report aims to describe the clinical characteristics of patients predisposed to this disabling complication after mastoid surgery and describes surgical treatment with mastoid cortex resurfacing with hydroxyapatite bone cement.
PATIENTS
Three patients who have undergone intact canal wall mastoidectomies for nonchronic middle ear-related pathologies all reported a similar constellation of postoperative symptoms. None of the patients had any ossicular chain or middle ear abnormalities, and none had preoperative conductive hearing loss. All patients reported disabling hyperacusis related to light touch stimuli in the periauricular area. On examination, all three patients demonstrated synchronous movement of the tympanic membrane when the postauricular area was palpated.
INTERVENTIONS
After a period of observation, none of the patients noted any improvement to their symptoms. Resurfacing of the mastoid cortex with hydroxyapatite bone cement was performed in all patients.
MAIN OUTCOME MEASURES
Presence of touch-induced hyperacusis and audiometry was assessed postoperatively. Patients were also examined for synchronous movement of the tympanic membrane with palpation of the postauricular area.
RESULTS
All patients experienced complete resolution of touch-induced hyperacusis postoperatively. Pure-tone audiometric hearing thresholds remained unchanged after mastoid cortex resurfacing, and there was no longer tympanic membrane movement with palpation of the postauricular area.
CONCLUSIONS
PMHS can occur in patients after cortical mastoidectomy when there is no history of ossicular chain or history of chronic middle ear disease or middle ear abnormalities. PMHS can cause significant distress to patients and remain underrecognized unless synchronous tympanic membrane movement is specifically examined for. Treatment via mastoid cortex surfacing with hydroxyapatite bone cement is safe and effective.
Topics: Audiometry, Pure-Tone; Bone Cements; Cadaver; Cholesteatoma, Middle Ear; Humans; Hydroxyapatites; Hyperacusis; Mastoid; Retrospective Studies; Treatment Outcome
PubMed: 36047684
DOI: 10.1097/MAO.0000000000003676 -
La Radiologia Medica Sep 2023Cholesteatoma is caused by disorders of the middle ear ventilation that trigger a progressive series of events responsible for its formation. The aim of this study was...
BACKGROUND
Cholesteatoma is caused by disorders of the middle ear ventilation that trigger a progressive series of events responsible for its formation. The aim of this study was to identify possible radiological CT-derived parameters predisposing to ventilation disorders and cholesteatoma.
METHODS
In this retrospective study, patients diagnosed with cholesteatomatous chronic otitis media who underwent temporal bone CT and open tympanoplasty surgery have been included, as well as control patients with clinical examination negative for organic otological pathology who underwent temporal bone CT for other reasons. For each patient, the following parameters have been extracted from CT volumes: degree of mastoid pneumatization, prominence of the cog, patency of the Eustachian tube, antrum width, aditus width, anterior and posterior epitympanic widths, and epitympanic height.
RESULTS
Sixty patients have been included, thirty of whom belonged to the group of patients with cholesteatoma and the remaining part to the group of patients without organic otological pathology. The prevalence of a low degree of mastoid pneumatization was significantly higher among patients with cholesteatoma, as well as for the prevalence of cog prominence (p < 0.001). All the continuous variables were found to have statistical significance (p < 0.05) in the comparison between groups except for the width of the antrum.
CONCLUSION
Mastoid pneumatization degree, prominence of the cog and epitympanic measures based on temporal bone CT could be good radiological correlates of the ventilatory capabilities of the epitympanum which, if compromised, can facilitate the development of cholesteatoma.
Topics: Humans; Cholesteatoma, Middle Ear; Retrospective Studies; Temporal Bone; Mastoid; Tomography, X-Ray Computed
PubMed: 37537372
DOI: 10.1007/s11547-023-01677-8 -
Surgical and Radiologic Anatomy : SRA Oct 2022To contribute to the documentation and consideration of the prevalence of the atlantomastoid muscle in humans.
PURPOSE
To contribute to the documentation and consideration of the prevalence of the atlantomastoid muscle in humans.
METHODS
Sixty formalin-fixed cadaveric sides were dissected for the presence of the atlantomastoid muscle (2 sides per donor). Laterality, origin, insertion, and other observable characteristics of the variant were recorded along with donor sex for comparative analyses.
RESULTS
The atlantomastoid muscle was observed in nine sides (15%): two left side only, three right side only, and 2 bilaterally. The origin of the muscle was consistent from the transverse process of the atlas, lateral to both the insertion of obliquus capitis inferior and the origin of obliquus capitis superior. In one instance, the origin of atlantomastoid was continuous with the most superior tendinous slip of levator scapulae. The insertion of each atlantomastoid variant was the mastoid process, however, the precise location was variable.
CONCLUSION
The atlantomastoid muscle is a common accessory muscle of the suboccipital region; the muscle was present in 15% of the cadaveric sides dissected in this study. Despite the notable prevalence of atlantomastoid muscles, there is little current literature dedicated to its study. Here, we document the first new information related to the prevalence of atlantomastoid since 1964 and discuss the development and potential clinical significance of the muscle.
Topics: Humans; Cadaver; Cross-Sectional Studies; Superficial Back Muscles; Head; Mastoid
PubMed: 36155834
DOI: 10.1007/s00276-022-03022-6 -
American Journal of Otolaryngology 2022To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship. (Observational Study)
Observational Study
BACKGROUND
To evaluate the epidemiology, management and outcome of acute mastoiditis (AM) in children and to improve strategies for antimicrobial stewardship.
METHODS
We conducted a retrospective observational study of children aged >6 months to ≤18 years of age admitted to a tertiary care hospital with AM over an 8-year period (2011-2019). Electronic medical records were reviewed to collect data.
RESULTS
A total of 129 patients met inclusion criteria for AM during this time period. Eighty-one (63 %) were males with 110 (81 %) White and 67 (52 %) non-Hispanic. The median age at presentation was 6.4 years (3-10.1 years). Ear protrusion was associated with reduced odds of having AM with intracranial extension (ICE) (OR 0.307, 95 % CI = 0.107-0.883) whereas presence of headaches and/or neck pain increased the odds of having AM with ICE (OR = 3.96, 95%CI 1.29-12.1). The most common etiologies were Streptococcus pyogenes (n = 23, 19.2 %), Pseudomonas aeruginosa (n = 20, 17 %), and Streptococcus pneumoniae (n = 15, 12.5 %). Empiric antibiotic selection and duration of therapy was highly variable. The most common empiric antibiotic used was intravenous vancomycin with a third generation cephalosporin (n = 45, 34.8 %). Majority completed course (n = 92; 73 %) with an oral antibiotic. Shorter (≤10 and ≤14 days) versus longer courses (>10 and >14 days) did not affect readmission rates for AM without ICE.
CONCLUSION
There is high variability of treatment of AM in children. Broad spectrum antibiotics, especially vancomycin were used most frequently despite low rates of Methicillin Resistant Staphylococcus aureus. The use of antibiotic stewardship is essential for judicious antibiotic use.
Topics: Acute Disease; Anti-Bacterial Agents; Cephalosporins; Child; Female; Humans; Infant; Male; Mastoiditis; Methicillin-Resistant Staphylococcus aureus; Retrospective Studies; Vancomycin
PubMed: 35724628
DOI: 10.1016/j.amjoto.2022.103520 -
Otolaryngology--head and Neck Surgery :... Nov 2021A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and...
OBJECTIVE
A small proportion of children with otitis media develop acute mastoiditis, which has the potential to spread intracranially and result in significant morbidity and mortality. The aim of this study was to evaluate the incidence and management of complications related to pediatric acute mastoiditis using a national database.
STUDY DESIGN
Retrospective review of 2016 Kids' Inpatient Database, part of the Healthcare Cost and Utilization Project.
SETTING
Academic, community, general, and pediatric specialty hospitals in the United States.
METHODS
code H70.XXX was used to retrieve records for children admitted with a diagnosis of mastoiditis. Data included patient demographics, intracranial infections, procedures (middle ear drainage, mastoidectomy, and intracranial drainage), length of stay (LOS), and total charges.
RESULTS
In total, 2061 children aged ≤21 years were identified with a diagnosis of acute mastoiditis. Complications included subperiosteal abscess (6.90%), intracranial thrombophlebitis/thrombosis (5.30%), intracranial abscess (3.90%), otitic hydrocephalus (1.20%), encephalitis (0.90%), subperiosteal abscess with intracranial complication (0.60%), petrositis (0.60%), and meningitis (0.30%). Children with intracranial abscesses were more likely ( < .001) to undergo myringotomy ± ventilation tube insertion (63.7%), mastoidectomy (53.8%), mastoidectomy with ventilation tube or myringotomy (42.5%), intracranial drainage procedure (36.3%), or all 3 key procedures (15.0%). Children with any type of intracranial complication had a significantly longer LOS ( < .001) and higher total charges ( < .001). Both a diagnosis of bacterial meningitis and undergoing an intracranial drainage procedure ( < .001) contributed significantly to LOS and total charges.
CONCLUSION
Patients with intracranial complications are more likely to undergo surgical procedures; however, there is still wide variability in practice patterns, illustrating that controversies in the management of otitis media complications persist.
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Hospital Charges; Humans; Infant; Length of Stay; Male; Mastoiditis; Practice Patterns, Physicians'; Retrospective Studies; United States; Young Adult
PubMed: 33588620
DOI: 10.1177/0194599821989633 -
International Journal of Pediatric... Jul 2022Septic arthritis of the Temporomandibular joint (TMJ) is a rare complication of acute middle ear infection. Presentation is elusive and could be easily missed. Often...
INTRODUCTION
Septic arthritis of the Temporomandibular joint (TMJ) is a rare complication of acute middle ear infection. Presentation is elusive and could be easily missed. Often diagnosis is made only with consequential development of TMJ ankylosis. This study intends to characterize patients and course of disease and suggest a diagnostic and therapeutic strategy.
METHODS
Retrospective review of all children diagnosed with TMJ arthritis and/or TMJ ankylosis secondary to acute middle ear infection, treated in a tertiary pediatric medical center between the years 2005 and 2021.
RESULT
Seven patients were identified with otogenic TMJ arthritis. Median age at presentation was 1.14 years (IQ range 1.1-1.5). All seven were diagnosed with acute mastoiditis. CT scans demonstrated TMJ related collections in 5/7 and intracranial complications in 3/7. Treatment included cortical mastoidectomy for 5/7. One patient had a concomitant surgical washout of the TMJ. Two patients had drainage only of subperiosteal collections. Six of the seven patients went on to develop TMJ ankylosis that presented within a median of 2.8 years (IQ range 2.6-3.9) after the episode of acute mastoiditis. All six patients presented with trismus and facial growth anomalies, and all but one required surgery to release the ankylosis.
CONCLUSION
Otogenic TMJ arthritis develops mostly in young children with acute mastoiditis and intratemproal and/or intracranial suppuration. Imaging is helpful in making the diagnosis, with TMJ related collections on CT being the most common finding. TMJ ankylosis can develop within a few years and present with trismus and abnormal facial growth. Cortical mastoidectomy does not seem to prevent ankylosis. It remains unclear whether focused treatment to the TMJ or physiotherapy could be beneficial in that.
Topics: Ankylosis; Arthritis, Infectious; Child; Child, Preschool; Humans; Infant; Mastoiditis; Otitis Media; Temporomandibular Joint; Temporomandibular Joint Disorders; Trismus
PubMed: 35500398
DOI: 10.1016/j.ijporl.2022.111163 -
European Archives of... Jun 2022To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients...
PURPOSE
To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center.
METHODS
We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis.
RESULTS
282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). 'Mastoidectomy' and 'Ossicular reconstruction' parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox.
CONCLUSION
Our results show the utility of SAMEO-ATO framework, and in particular of 'M' (Mastoidectomy) and 'O' (Ossicular reconstruction) parameters, in predicting the hearing outcome.
Topics: Adult; Cholesteatoma, Middle Ear; Humans; Mastoid; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34309753
DOI: 10.1007/s00405-021-07000-3 -
International Journal of Pediatric... Feb 2023To determine the key image anatomical parameters that are relevant to cochlear implantation (CI) using temporal bone high-resolution computed tomography (HRCT) scans and...
OBJECTIVES
To determine the key image anatomical parameters that are relevant to cochlear implantation (CI) using temporal bone high-resolution computed tomography (HRCT) scans and to identify age group differences in order to provide image anatomical support for early CI.
METHODS
The data of 346 temporal bone HRCTs of 173 children from 5 months to 18 years of age were retrospectively selected and reviewed. Parameters of the human temporal bone that are relevant to CI key surgical steps include mastoid thickness (MT), the facial recess width (FRW), and an angle representing the round window visibility. All measurements are performed on axial images.
RESULTS
There was no significant difference in the above morphological values by gender (p > 0,05). Two-sided FRW was not significantly different (p > 0,05), but MT and angle A were significantly different (p < 0,001). FRW and angle were independent of age (p > 0,05). However, MT had been found to exhibit postnatal development. The linear function of MT were calculated as y = 2463 × group(s) + 20,574 (p < 0,001).
CONCLUSIONS
Based on preoperative imaging analysis at different ages, middle ear development was stable at 5 months of age, allowing early CI in infancy with severe to severe hearing loss at this age. These data must be considered exploratory and more extensive clinical studies are needed.
Topics: Child; Humans; Infant; Cochlear Implantation; Retrospective Studies; Feasibility Studies; Temporal Bone; Mastoid; Round Window, Ear; Cochlear Implants
PubMed: 36634570
DOI: 10.1016/j.ijporl.2022.111433