-
Journal of Neurosurgery. Pediatrics Jul 2023Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Neurosurgical outcomes are not well defined in the management of pediatric patients with cerebral venous sinus thrombosis (CVST) following acute mastoiditis. Specific notable sequelae are otogenic (otitic) hydrocephalus and CVST management. Correspondingly, the aim of this study was to integrate the currently published metadata to summarize these outcomes.
METHODS
Electronic searches were performed using the Ovid Embase, PubMed, Scopus, and Cochrane databases from inception to November 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort-level data were then abstracted for analysis for appropriate pediatric patients. Outcomes were pooled by random-effects meta-analyses of proportions where possible.
RESULTS
Twenty-three study cohorts describing 312 pediatric patients with otogenic CVST were included. At a cohort level, the median patient age was 6 years among 181 boys (58%) and 131 girls (42%). Modeling indicated papilledema at presentation in 46% of cases (95% CI 30%-62%). Regarding management, antibiotics were applied universally in all cases, mastoidectomy or other otologic surgery was performed in 91% (95% CI 82%-98%), and prophylactic anticoagulation was administered in 86% (95% CI 75%-95%). There was only 1 case (0.3%) of postprocedural intracranial hemorrhage, and there were no deaths reported among all studies. Although diagnostic lumbar puncture was performed in 14% (95% CI 3%-28%) at presentation, clinical otogenic hydrocephalus was ultimately suspected in 31% (95% CI 14%-49%), and acetazolamide was given in 65% (95% CI 35%-91%) overall. There were 10 cases (3%) that proceeded to permanent CSF diversion in the form of ventricular shunting. At a median follow-up of 8 months among all studies, the venous sinus was completely recanalized in 67% (95% CI 53%-79%).
CONCLUSIONS
Most CVSTs following acute mastoiditis will recanalize with the standard use of antibiotics, otologic surgery, and anticoagulation, with minimal symptomatic hemorrhage risk. However, an appreciable proportion of these patients will develop symptomatic otogenic hydrocephalus, and it is imperative that the appropriate surveillance and workup is performed to fully optimize patient outcomes long-term. The possible need for permanent CSF diversion should be recognized.
Topics: Male; Female; Child; Humans; Mastoiditis; Otitis Media; Anticoagulants; Hydrocephalus; Sinus Thrombosis, Intracranial; Anti-Bacterial Agents; Retrospective Studies
PubMed: 37060317
DOI: 10.3171/2023.2.PEDS2319 -
BMJ Clinical Evidence Aug 2012Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment and disability. Occasionally it can lead to fatal intracranial infections and acute... (Review)
Review
INTRODUCTION
Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment and disability. Occasionally it can lead to fatal intracranial infections and acute mastoiditis, especially in developing countries.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic suppurative otitis media in adults and in children? What are the effects of treatments for cholesteatoma in adults and in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 51 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: topical ear cleansing, surgery for cholesteatoma, systemic antibiotics, topical antibiotics, topical antibiotics plus topical corticosteroids, topical antiseptics, topical corticosteroids, tympanoplasty (with or without mastoidectomy).
Topics: Anti-Bacterial Agents; Chronic Disease; Humans; Mastoid; Otitis Media, Suppurative; Tympanoplasty
PubMed: 23870746
DOI: No ID Found -
The Journal of Laryngology and Otology Oct 2022Epithelial migration has been associated with the self-cleansing mechanism of the ear. The rate and pattern of epithelial migration in healthy and pathological ears are... (Review)
Review
BACKGROUND
Epithelial migration has been associated with the self-cleansing mechanism of the ear. The rate and pattern of epithelial migration in healthy and pathological ears are reviewed.
METHODS
Two authors independently screened articles over one month using the following search terms: epithelial migration, epithelial, tympanic membrane, external auditory canal and mastoidectomy cavity.
RESULTS
Ten studies were included. The fastest rate of epithelial migration was observed in the external auditory canal, with a mean of 144.75 μm per day, whereas the slowest epithelial migration was seen in post-mastoidectomy cavities, with a rate of 20 μm per day. Epithelial migration was present in both studies involving post-mastoidectomy cavities.
CONCLUSION
Epithelial migration is faster in healthy tympanic membrane than in pathological tympanic membrane. The rate of epithelial migration in the external auditory canal was higher in the pathological group than in the healthy group. Epithelial migration is present in post-mastoidectomy cavities.
Topics: Ear Canal; Humans; Mastoid; Tympanic Membrane
PubMed: 34725011
DOI: 10.1017/S0022215121003376 -
Journal of Clinical Medicine Sep 2023This systematic review was aimed at gathering the clinical and technical applications of CAD/CAM technology for craniofacial implant placement and processing of... (Review)
Review
This systematic review was aimed at gathering the clinical and technical applications of CAD/CAM technology for craniofacial implant placement and processing of auricular prostheses based on clinical cases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic data search was performed. Human clinical studies utilizing digital planning, designing, and printing systems for craniofacial implant placement and processing of auricular prostheses for prosthetic rehabilitation of auricular defects were included. Following a data search, a total of 36 clinical human studies were included, which were digitally planned and executed through various virtual software to rehabilitate auricular defects. Preoperative data were collected mainly through computed tomography scans (CT scans) (55 cases); meanwhile, the most common laser scanners were the 3dMDface System (3dMD LLC, Atlanta, Georgia, USA) (6 cases) and the 3 Shape scanner (3 Shape, Copenhagen, Denmark) (6 cases). The most common digital design software are Mimics Software (Mimics Innovation Suite, Materialize, Leuven, Belgium) (18 cases), Freeform software (Freeform, NC, USA) (13 cases), and 3 Shape software (3 Shape, Copenhagen, Denmark) (12 cases). Surgical templates were designed and utilized in 35 cases to place 88 craniofacial implants in auricular defect areas. The most common craniofacial implants were Vistafix craniofacial implants (Entific Medical Systems, Goteborg, Sweden) in 22 cases. A surgical navigation system was used to place 20 craniofacial implants in the mastoid bone. Digital applications of CAD/CAM technology include, but are not limited to, study models, mirrored replicas of intact ears, molds, retentive attachments, customized implants, substructures, and silicone prostheses. The included studies demonstrated a predictable clinical outcome, reduced the patient's visits, and completed the prosthetic rehabilitation in reasonable time and at reasonable cost. However, equipment costs and trained technical staff were highlighted as possible limitations to the use of CAD/CAM systems.
PubMed: 37762891
DOI: 10.3390/jcm12185950 -
Otology & Neurotology : Official... Sep 2008To review systematically the literature for the current criteria and strategies used to diagnose acute mastoiditis in children. (Review)
Review
OBJECTIVE
To review systematically the literature for the current criteria and strategies used to diagnose acute mastoiditis in children.
METHOD
A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library of studies on the diagnosis of acute mastoiditis in children published between January 1980 and September 2007. The study type and setting, diagnostic criteria for acute mastoiditis, disease-specific history, presenting otologic and systemic signs and symptoms, diagnostic procedures, and final diagnosis were identified.
RESULTS
The initial search resulted in 1,057 articles. The inclusion criteria were met in 65; 44 were retrospective case series, and 21 were case reports. These studies included 2,109 children with a median age of 32 months (range, 0 mo-18 yr). Only 26 of 65 articles reported the criteria upon which the diagnosis of acute mastoiditis in children was based. The criteria most frequently used were the clinical signs of postauricular swelling, erythema, tenderness, and protrusion of the auricle. The most frequently used imaging modality was computed tomographic (CT) scanning (reported in 39 of 65 studies, performed in 68% of patients). The most frequently used laboratory test was white blood count (100% of patients in 45 of 65 studies). In 63 studies, the result of culturing from the otomastoid was reported: Streptococcus pneumoniae was the most frequently isolated bacterium.
CONCLUSION
Acute mastoiditis in children is an entity that is poorly evaluated and understood in the modern literature. There is a lack of consensus regarding the criteria and strategies for diagnosing acute mastoiditis in the pediatric population. It is crucial that such criteria are established, and consensus is achieved so that prognostic and controlled studies can be initiated to identify risk factors and establish the most effective management of this condition in children.
Topics: Acute Disease; Child; Humans; Mastoiditis; Otitis Media
PubMed: 18617870
DOI: 10.1097/MAO.0b013e31817f736b -
Otolaryngology--head and Neck Surgery :... Oct 2016We sought to assess the complication rates following cochlear implantation in canal wall down mastoid cavities in adults and children. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We sought to assess the complication rates following cochlear implantation in canal wall down mastoid cavities in adults and children.
DATA SOURCES
A systematic review of English articles from PubMed, Web of Science, EMBASE, and the Cochrane Library. Additional studies were identified by reviewing the reference lists of the originally identified studies.
REVIEW METHODS
Studies were included that reported on surgical outcomes following cochlear implantation in canal wall down mastoid cavities. Two authors, using predefined data fields, independently reviewed all articles while tabulating study quality indicators. A meta-analysis of proportions was conducted on select cohorts to determine weighted complication rates.
RESULTS
Forty-two articles were included that accounted for 424 patients and described surgical outcomes following cochlear implantation in canal wall down mastoid cavities. In a comparison of the postoperative complication rates, overclosing the external auditory meatus had significantly fewer global complications than did maintaining a canal wall down mastoid cavity (P = .027). In a comparison of the complication rates (1) between staging the cochlear implantation and performing external auditory meatus overclosure simultaneously with cochlear implantation and (2) between pediatric and adult cochlear implantation recipients with external auditory meatus overclosure, there were no significant differences (P = .085 and P = .92, respectively).
CONCLUSION
Overclosing the external auditory meatus at the same time of cochlear implantation leads to significantly fewer complications when compared with maintaining a canal wall down mastoid cavity with soft tissue coverage of the electrode array.
Topics: Cochlear Implantation; Cochlear Implants; Humans; Mastoid; Postoperative Complications
PubMed: 27221577
DOI: 10.1177/0194599816651239 -
Journal of Forensic and Legal Medicine Oct 2023The mastoid process has attracted the attention of several researchers due to its protected position at the base of the skull and the fact that it is relatively compact,... (Review)
Review
The mastoid process has attracted the attention of several researchers due to its protected position at the base of the skull and the fact that it is relatively compact, in addition to being highly resistant and dimorphic, considered as a gold standard anatomical structure in the determination of the sexual dimorphism of skulls. However, intrinsic and extrinsic factors may influence this anatomical structure over time, providing contradictory and ambiguous data. Therefore, other anatomical structures need to be evaluated concurrently with the mastoid process to provide better accuracy and reliability of skull sexual dimorphism data. Thus, the objective of this systematic review was to evaluate the degree of reliability of the mastoid process to determine sexual dimorphism compared to other dimorphic structures, since there are still no systematic reviews on the subject in the literature. This review follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was recorded in the Prospective International Systematic Reviews Registry (PROSPERO) (CRD 42023395167 Systematic Registry) (CRD420223). The inclusion criteria for selecting the studies were based on the PICO question: "Are skull anatomical structures reliable as alternatives to determine sexual dimorphism compared to the mastoid process?". A literature search for studies was performed in the MEDLINE Scopus, Web of Science, LILACS, and Cochrane Library databases. The Kappa agreement presented an approval level of (k = 0.93). This systematic review analyzed 13 ex-vivo studies published between 2008 and 2023. The risk of bias was considered low in 12 of the studies, and high in 1 study. Based on the findings, it can be concluded that even with the limitations of this systematic review, quantitative and qualitative analyses are essential in sexual identification of human skulls, and different anatomical structures can be used as references in addition to the mastoid process, with high reliability and precision, among them the; glabella, frontal profile, superciliary arch, bizygomatic width, maximum cranial length, and nasal height.
PubMed: 37742445
DOI: 10.1016/j.jflm.2023.102592 -
BMJ Clinical Evidence Feb 2007Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment, disability, and poor scholastic performance, and can occasionally lead to fatal... (Review)
Review
INTRODUCTION
Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment, disability, and poor scholastic performance, and can occasionally lead to fatal intracranial infections and acute mastoiditis, especially in resource-poor countries.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic suppurative otitis media in adults; and in children? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 48 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: ear cleansing, systemic antibiotics, topical antibiotics, topical antiseptics, topical corticosteroids, tympanoplasty (with or without mastoidectomy).
Topics: Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chronic Disease; Humans; Otitis Media, Suppurative; Tympanoplasty
PubMed: 19454051
DOI: No ID Found -
Otology & Neurotology : Official... Sep 2022This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma.
DATABASES REVIEWED
According to PRISMA guidelines, English articles in PubMed, Scopus, CINAHL, and Cochrane Library databases from inception to 7/29/2021 were searched.
METHODS
Studies describing a comparison of patients who underwent T to patients who underwent T&M were included. Studies describing patients with cholesteatoma were excluded. Patient demographics, graft failure rates, and preoperative and postoperative audiological findings were collected. Mean differences (MD) and risk difference (RD) were calculated using RevMan 5.4. Heterogeneity was assessed using Q test and I2 statistic. Risk of bias was assessed using both version 2 of the Cochrane risk-of-bias tool for randomized trials and Risk of Bias in Non-randomized Studies of Interventions.
RESULTS
A total of 27 studies fulfilled eligibility with T (n = 1,711) and T&M (n = 1,186). When pooling the data, mean differences between T versus T&M for air bone gap (-0.3 dB: 95% CI = -1.9 to 1.3, p = 0.730) and pure tone average (1.9 dB: 95% CI = -0.3 to 4.2, p = 0.090) were not statistically significant. Graft failure was higher with T only (16.4% versus 14.2%) than T&M (RD = -0.04, 95% CI = -0.07 to -0.00, p = 0.030, I2 = 35%].
CONCLUSION
This study endorses clinically similar audiological outcomes and a reduced risk difference of graft failure with mastoidectomy. Although these data suggest that adding a mastoidectomy could decrease the risk of graft failure, the risk reduction is minimal. More research on the cost-effectiveness and the specific patient clinical characteristics and comorbidities that would benefit from adding a mastoidectomy is warranted.
Topics: Cholesteatoma; Cholesteatoma, Middle Ear; Chronic Disease; Humans; Mastoid; Mastoidectomy; Otitis Media; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 35970151
DOI: 10.1097/MAO.0000000000003631 -
Otolaryngology--head and Neck Surgery :... Jan 2017Objective The aim of this report is to provide a review of the current literature for assessment of performance for mastoidectomy, to identify the current assessment... (Review)
Review
Objective The aim of this report is to provide a review of the current literature for assessment of performance for mastoidectomy, to identify the current assessment tools available in the literature, and to summarize the evidence for their validity. Data Sources The MEDLINE database was accessed via PubMed. Review Methods Inclusion criteria consisted of English-language published articles that reported use of a mastoidectomy performance assessment tool. Studies ranged from 2007 to November 2015 and were divided into 2 groups: intraoperative assessments and those performed with simulation (cadaveric laboratory or virtual reality). Studies that contained specific reliability analyses were also highlighted. For each publication, validity evidence data were analyzed and interpreted according to conceptual definitions provided in a recent systematic review on the modern framework of validity evidence. Conclusions Twenty-three studies were identified that met our inclusion criteria for review, including 4 intraoperative objective assessment studies, 5 cadaveric studies, 10 virtual reality simulation studies, and 4 that used both cadaveric assessment and virtual reality. Implications for Practice A review of the literature revealed a wide variety of mastoidectomy assessment tools and varying levels of reliability and validity evidence. The assessment tool developed at Johns Hopkins possesses the most validity evidence of those reviewed. However, a number of agreed-on specific metrics could be integrated into a standardized assessment instrument to be used nationally. A universally agreed-on assessment tool will provide a means for developing standardized benchmarks for performing mastoid surgery.
Topics: Clinical Competence; Humans; Mastoid; Osteotomy; Quality Assurance, Health Care
PubMed: 27677598
DOI: 10.1177/0194599816670886