-
The Journal of International Advanced... Dec 2019Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of... (Review)
Review
Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the main techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. The materials used for this reason are either biological or synthetic. The purpose of this survey is to review the published literature related to the therapeutic value of mastoid obliteration with synthetic materials. We searched Web of Science, PubMed, and MEDLINE from 2008 to 2018 using the criteria mastoid obliteration, canal wall down mastoidectomy, chronic otitis media, and cholesteatoma. The search focused on papers concerning the mastoid obliteration with synthetic material, as we focused on looking for outcomes and reported complications. Out of a total of 244 citations, 15 articles were identified, where patients underwent mastoid obliteration with synthetic materials. Most authors used bioactive glass as a filler material. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. On the basis of the available limited literature, it seems that mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. The bioactive glass appears to be the most reliable synthetic material.
Topics: Cholesteatoma, Middle Ear; Chronic Disease; Ear Canal; Humans; Mastoid; Mastoidectomy; Otitis Media; Surgical Flaps; Treatment Outcome
PubMed: 31846919
DOI: 10.5152/iao.2019.7038 -
Laryngoscope Investigative... Jun 2020The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery.
OBJECTIVES
The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery.
METHODS
Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border.
RESULTS
Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated.
CONCLUSION
The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss.
LEVEL OF EVIDENCE
3.
PubMed: 32596499
DOI: 10.1002/lio2.403 -
International Journal of Surgery Case... Jun 2021Tuberculosis of the ear and temporal bone is an extremely rare case.
BACKGROUND
Tuberculosis of the ear and temporal bone is an extremely rare case.
METHODS
This case series was reported using the 2020 PROCESS Guideline. The design of this study used a retrospective study during the 2017-2019 period.
RESULTS
Four cases of tuberculosis mastoiditis with age range between 16 and 66 years from 2016 to 2019. All patients presented with chronic ear discharge from chronic ear with signs of mastoiditis with intra- and extra-temporal complications. All patients underwent radical mastoidectomy, and histopathologic examination showed tuberculosis. All patients received anti-tuberculosis drug first and second category.
CONCLUSION
Clinical features of tuberculosis mastoiditis may vary. The diagnosis of tuberculosis mastoiditis can be examined through histopathologic examination and geneXpert tuberculosis. Surgical treatment and anti-tuberculosis administration are the primary choices in the management of tuberculosis mastoiditis.
PubMed: 34062356
DOI: 10.1016/j.ijscr.2021.106029 -
Indian Journal of Otolaryngology and... Aug 2022To compare the outcome and efficacy of mastoid obliteration following canal wall down mastoidectomy, using two different materials such as bone pâté and bioactive...
To compare the outcome and efficacy of mastoid obliteration following canal wall down mastoidectomy, using two different materials such as bone pâté and bioactive glass granules. This is a prospective, randomized, single blind comparative study conducted for a period of 2 years in a tertiary care center. The patients were divided into two groups A and B. In , the mastoid was obliterated with and inferiorly based musculoperiosteal flap and in with inferiorly based musculoperiosteal flap. They were assessed post operatively at 4th, 12th and 24th week for cavity healing (merchant et.al., score), subjective satisfaction and at the 24th week the effectiveness of obliteration was assessed visually by oto endoscopy and HRCT was done additionally to assess the volume of external auditory canal. A total of 40 patients with chronic otitis media (Squamosal type) were included and divided into 2 groups. At the end of 4 weeks, bioactive glass had better healing, which was statistically significant. At the end of 24 weeks both groups had similar rate of healing. There was no difference in subjective satisfaction at end of 24 weeks. The patients in bioactive glass group had statistically better obliteration than Group A and the volume of the EAC was less in this group signifying better obliteration. The cavity healing were similar for both bone pâté and Bioactive glass at end of 24 weeks. Bioactive glass had better outcomes for effectiveness of obliteration compared to bone pâté.
PubMed: 36032926
DOI: 10.1007/s12070-021-02472-5 -
Radiologia 2021The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used...
OBJECTIVE
The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used iin middle ear surgery. Knowledge of these factors will enable normal postsurgical changes to be differentiated from complications. This article describes the most common surgical procedures in the middle ear, their indications, and the normal radiological appearance after these procedures. It reviews the most common causes of failure in stapes surgery, in surgery for chronic otitis media, and in surgery for cholesteatoma, suggesting the best imaging method to assess the middle ear in each case.
CONCLUSION
Computed tomography enables the evaluation of prostheses and the aeration of the cavities, whereas magnetic resonance imaging makes it possible to characterize the possible occupation of the cavities and is the technique of choice for the follow-up of closed mastoidectomy for cholesteatomas.
Topics: Cholesteatoma, Middle Ear; Ear, Middle; Humans; Mastoid; Mastoidectomy; Treatment Outcome
PubMed: 34625199
DOI: 10.1016/j.rxeng.2021.04.006 -
World Journal of Clinical Cases Jan 2022Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease. Teratomas involving the temporal bone are particularly scarce.
BACKGROUND
Mature teratoma composed of all three basic germ cell layers of the head and neck is a rare disease. Teratomas involving the temporal bone are particularly scarce.
CASE SUMMARY
A 48-year-old male patient with a history of chronic otitis of the left ear from infancy, for which he had been operated on twice, was referred to our hospital for chronic otitis, cholesteatoma and a middle ear mass. Computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a eustachian tube teratoma, in which the anterior lower part and posterior upper part were connected by a thin membranaceous tissue. The mass was removed completely under general anesthesia by mastoidectomy. As of last follow-up (2 years post-surgery), the disease had not relapsed.
CONCLUSION
Pre-operative CT and MRI are necessary for eustachian tube teratoma. Complete surgical resection provided excellent prognosis.
PubMed: 35071534
DOI: 10.12998/wjcc.v10.i1.316 -
Turkish Archives of Otorhinolaryngology Mar 2023This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery.
OBJECTIVE
This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery.
METHODS
Twenty-seven cholesteatoma patients that had undergone transcanal endoscopic ear surgery (TEES) were included in the study. Age, sex, operation date of patients, operated side, need for ossiculoplasty, graft material, and surgical technique were recorded. All patients were evaluated through otoscopic, endoscopic, and audiological examinations and followed up for at least five months after surgery. All patients were staged using the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) Staging System on Middle Ear Cholesteatoma.
RESULTS
Mean age of the patients was 36.4 years (range, 4-67 years). According to the EAONO/JOS Staging System, 11 patients were stage 1, while 11 were stage 2, and five were stage 3. Two had lateral semicircular canal defect, one had facial canal dehiscence, and one had oval window defect. The average follow-up period was 19 months (range, 5-41 months), during which two patients experienced retraction pocket and hearing loss and one patient had perforation. One patient underwent revision surgery during follow-up and no recurrence or residual cholesteatoma was observed. The preoperative and postoperative air-bone gaps were 25.14±13.93 dB and 22.22±12.64 dB with no significant difference.
CONCLUSION
TEES is a minimally invasive and safe procedure with low complication and recurrence rates. As with all surgical procedures, experience is essential, and as experience increases, the capability to perform endoscopic otologic surgery on more complex cases may become possible.
PubMed: 37583974
DOI: 10.4274/tao.2023.2022-11-6 -
BMC Surgery Jun 2023This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
OBJECTIVE(S)
This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
METHODS
The clinical records of children diagnosed with CG were retrospectively reviewed.
RESULTS
The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months.
CONCLUSION(S)
The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.
Topics: Humans; Child; Retrospective Studies; Tympanic Membrane; Ear, Middle; Granuloma; Cholesterol
PubMed: 37312115
DOI: 10.1186/s12893-023-02069-5 -
Indian Journal of Otolaryngology and... Aug 2022This study has aimed to determine the anatomical site of labyrinthine fistula in patients of chronic suppurative otitis media at our centre. Labyrinthine fistulae (LF)...
This study has aimed to determine the anatomical site of labyrinthine fistula in patients of chronic suppurative otitis media at our centre. Labyrinthine fistulae (LF) are caused by abnormal communications between the inner ear and surrounding structures resulting in perilymph leakage and hearing loss. Labyrinthine fistula represents as erosive loss of the enchondral bone overlying the semicircular canals without loss of perilymph. The manifestations of fistula like vertigo, hearing loss vary in severity and complexity, commonly ranging from very mild to incapacitating. Cholesteatoma induced fistula most commonly involves lateral semicircular canal probably because of its close proximity to the middle ear, but can involve other semicircular canals and rarely cochlea. This is a retrospective analysis of 36 patients of chronic suppurative otitis media with history of vertigo undergoing tympanomastoid surgery in whom there was an evidence of labyrinthine fistula on HRCT scan of temporal bone. The incidence of patients with labyrinthine fistula presenting with vertigo, nystagmus, sensorineural hearing loss, history of vertigo were analysed. The anatomical location of the fistula was supported by Radiological evidence. Patients underwent either canal wall down mastoidectomy or cortical mastoidectomy. The anatomical site and length of the labyrinthine fistula were analysed. Amongst the 36 patients of chronic suppurative otitis media with labyrinthine fistula 22 (61.1%) patients had atticoantral disease, 4 (11.1%) patients had chronic otitis media with extensive granulation, 2 (5.5%) patients had Tubotympanic disease with polyps, 4 (11.1%) patients had Tuberculous otitis media, 1 (2.77%) patient had Tubotympanic disease with extensive tympanosclerosis eroding the dome of lateral semicircular canal, 1 (2.77%) patient had extensive cholesteatoma with cerebellar abscess, 1 (2.77%) patient had fistula in the promontory following trauma, 1 (2.77%) patient had extensive tympanosclerosis with erosion of promontory. It was noticed that, in 14 (38.88%) patients the fistula was at the centre, in 17 (47.22%) patients the fistula is towards the ampullary end of horizontal semicircular canal and in 5 (13.88%) patients the fistula was towards the non ampullary end of lateral semicircular canal. The maximum length of fistula noticed was 6 mm and the minimum length of the fistula noticed was 2 mm. Labyrinthine fistula are most commonly noticed in the ampullary end of the lateral semicircular canal. The average length of the fistula was found to be 4 mm. Careful elevation of the cholesteatoma matrix over the endosteal membrane and immediate placement of temporal fascia over the exposed fistula is important to avoid injury to the inner ear. Maximum number of fistula were seen in the atticoantral type of Chronic suppurative otitis media. Prior knowledge of anatomical location of the fistulous tract in HRCT temporal bone is important to address the fistula.
PubMed: 36032823
DOI: 10.1007/s12070-020-01857-2 -
International Archives of... Apr 2021The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a...
The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and the WHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles. Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy. Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. The Otorhinolaryngology Surgical Team of Walter Cantídio Hospital developed the barrier for particle dispersion presented here. During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent. Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary.
PubMed: 33968236
DOI: 10.1055/s-0040-1718960