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AORN Journal Jun 2019
Topics: Cochlear Implantation; Humans; Mastoid; Mastoidectomy; Mastoiditis; Treatment Outcome
PubMed: 31135980
DOI: 10.1002/aorn.12734 -
Ear, Nose, & Throat Journal Nov 2020To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea. (Review)
Review
OBJECTIVES
To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea.
METHODS
The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords.
RESULTS
Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Nevertheless, chronic otorrhea refractory to an otolaryngologist's traditional treatment algorithm still occurs and may benefit from a mastoidectomy with antibiotic irrigation using a catheter in certain cases. We theorize that resolution of otorrhea results from this technique by decreasing the burden of diseased mucosa and providing a larger concentration or dose of antibiotic to the middle ear cleft through the antrum. High-resolution images of the technique and catheter placement are included in this review.
CONCLUSIONS
Despite being an uncommon management strategy, the literature suggests an indication for performing a mastoidectomy in a small percentage of patients with a chronically draining tympanostomy tube.
Topics: Anti-Bacterial Agents; Catheters; Child; Child, Preschool; Chronic Disease; Drainage; Female; Humans; Male; Mastoidectomy; Mastoiditis; Middle Ear Ventilation; Otitis; Otitis Media with Effusion; Prosthesis-Related Infections; Therapeutic Irrigation
PubMed: 32189520
DOI: 10.1177/0145561320913350 -
World Neurosurgery Aug 2018Over the past 30 years, the application of robotics in the field of neurotology has grown. Robots are able to perform increasingly complex tasks with ever improving... (Review)
Review
Over the past 30 years, the application of robotics in the field of neurotology has grown. Robots are able to perform increasingly complex tasks with ever improving accuracy, allowing them to be used in a broad array of applications. A mastoidectomy, in which a drill is used to remove a portion of the mastoid part of the temporal bone at the base of the skull, is one such application. To determine the current state of neurotologic robotics in the specific context of mastoidectomy, a review of the literature was carried out. This qualitative review explores what has been done in this field to date, as well as what has yet to be done. Although the research suggests that robotics can be and has been successfully used to assist with mastoidectomy, it also suggests the incompleteness of robotic development in the field. At present, only 2 robotic systems have been approved by the U.S. Food and Drug Administration for neurosurgical use and the literature lacks evidence of meaningful clinical testing of new systems to change that. The cost of robotics also remains prohibitive. However, strides have been made, with at least 1 robot for mastoidectomy having reached the point of cadaveric trials. In addition, the research suggests some of the characteristics that should be considered when designing robots for mastoidectomy, such as burr size and the type of forces that should be applied. Overall, the outlook for robots in neurotology, particularly mastoidectomy, is bright but some hurdles still remain to be overcome.
Topics: Humans; Mastoid; Mastoidectomy; Robotics; Surgery, Computer-Assisted; Surgical Instruments; Temporal Bone
PubMed: 29870847
DOI: 10.1016/j.wneu.2018.05.194 -
European Archives of... Mar 2023Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM).... (Review)
Review
PURPOSE
Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature.
METHODS
Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines.
RESULTS
The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review.
CONCLUSIONS
Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.
Topics: Humans; Mastoidectomy; Treatment Outcome; Prospective Studies; Cholesteatoma, Middle Ear; Tympanic Membrane; Tympanoplasty; Retrospective Studies; Mastoid
PubMed: 35947150
DOI: 10.1007/s00405-022-07573-7 -
International Archives of... Apr 2016Introduction Posterior tympanotomy approach for cochlear implant (CI) surgery, has been the most commonly used worldwide with current 0.7% rate of facial nerve injury.... (Review)
Review
Introduction Posterior tympanotomy approach for cochlear implant (CI) surgery, has been the most commonly used worldwide with current 0.7% rate of facial nerve injury. Non-mastoidectomy CI approaches include the suprameatal approach (SMA) and its modifications, the transcanal approach and its modifications and the pericanal approach for electrode insertion. Objectives The objective of this study was to review the literature regarding non-mastoidectomy CI approaches. Data Synthesis A search was performed in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in February 2015, and the key words used in the search were CI, SMA, transcanal approach, pericanal approach, or electrode extrusion. About 30 studies that met the criteria described in "Study Selection" were read in full. The studies showed 1014 patients that underwent CI by SMA or its modifications, 266 CI patients treated by transcanal approach or its modifications, and 15 patients implanted by the pericanal approach. Reported complication with SMA was 99 (9.8%) minor and 13 (1.3%) major. With transcanal, there were 24 complications; 19 (7.1%) minor and 5 (1.9%) major. No post-operative complication was reported in pericanal approach. Studies showed no reported facial nerve paresis or paralysis in all non-mastoidectomy approaches. Conclusion Complications rates with non-mastoidectomy approaches are similar to those found in the mastoidectomy approach. Thus, non-mastoidectomy approaches may be an alternative in cases where the conventional mastoidectomy approach is difficult to perform. It would be helpful for CI surgeons to become familiarized with these approaches.
PubMed: 27096025
DOI: 10.1055/s-0035-1558871 -
Otology & Neurotology : Official... Mar 2018
Topics: Mastoid; Mastoidectomy; Tympanoplasty
PubMed: 29424823
DOI: 10.1097/MAO.0000000000001724 -
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 -
The Journal of Laryngology and Otology May 2023Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It...
OBJECTIVE
Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It was hypothesised that endoscopic hydro-mastoidectomy might take less time than endoscopic non-underwater mastoidectomy because the endoscope does not need to be removed for cleaning.
METHODS
This study compared the mastoidectomy and total operative durations between the endoscopic hydro-mastoidectomy ( = 25) and endoscopic non-underwater drilling (control, = 8) groups. Moreover, it compared the size of resected areas of the external auditory canal between the two groups.
RESULTS
The mastoidectomy time of the endoscopic hydro-mastoidectomy group was significantly shorter than that of the control group ( < 0.01). The total operative time did not differ significantly between the endoscopic hydro-mastoidectomy and control groups ( = 0.17). The resected area was significantly larger in the endoscopic hydro-mastoidectomy group than in the control group ( < 0.05).
CONCLUSION
Endoscopic hydro-mastoidectomy enables more extensive bone resection within a shorter period.
Topics: Humans; Mastoidectomy; Cholesteatoma, Middle Ear; Treatment Outcome; Otologic Surgical Procedures; Endoscopy; Mastoid; Retrospective Studies
PubMed: 35611600
DOI: 10.1017/S0022215122001244 -
The Annals of Otology, Rhinology, and... Apr 2023Video-based coaching might complement general surgery education, but little is known of its applicability for otologic microsurgical teaching. Our purpose was thus to...
OBJECTIVES
Video-based coaching might complement general surgery education, but little is known of its applicability for otologic microsurgical teaching. Our purpose was thus to evaluate the content and resident-perceived benefit of video-based coaching for mastoidectomy education.
METHODS
In this mixed-methods pilot design, mastoidectomies were recorded from operative microscopes and reviewed during 30-minute video-based coaching sessions at 2 tertiary care centers. Eight residents and 3 attendings participated. Ten-point Likert-type questionnaires on the extent to which attendings taught 12 topics through 8 techniques were completed by residents after surgical and coaching sessions. Coaching sessions and structured interviews with residents were audio-recorded, transcribed and iteratively coded.
RESULTS
Seven audio-recordings were available for coaching sessions, during which a mean of 2.22 ± 0.5 topics per minute were discussed. Of the 12 teaching topics, technique was discussed most frequently (32%, 0.71 ± 0.2 topics/min), followed by anatomy (16%, 0.31 ± 0.16 topics/min). Of all 8 ratings between coaching and operative sessions, residents indicated a greater extent of discussion of anatomy (median difference, [95% confidence interval (CI)] of 3 [1-4]), progress (2.25 [95% CI, 0.5-4]), technique (3.5 [95% CI, 1.5-5.5]), pitfalls (2.5 [95% CI, 1-3.5]), and summarizing (3 [95% CI, 1-5]). In structured interviews, residents reported improved self-confidence and global perspective.
CONCLUSIONS
Video-based coaching is educationally dense and characterized by perceived richer teaching and promotion of a deeper surgical understanding. It requires no additional resources, can be completed in a short period of time and can be implemented programmatically for any otolaryngologic subspecialty utilizing video-recording capable equipment.
Topics: Humans; Mastoidectomy; Mentoring; Internship and Residency; Video Recording; Clinical Competence
PubMed: 35658718
DOI: 10.1177/00034894221098804