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Journal of Surgical Education 2017A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work... (Review)
Review
OBJECTIVE
A method for rating surgical performance of a mastoidectomy procedure that is shown to apply universally across teaching institutions has not yet been devised. This work describes the development of a rating instrument created from a multi-institutional consortium.
DESIGN
Using a participatory design and a modified Delphi approach, a multi-institutional group of expert otologists constructed a 15-element task-based checklist for evaluating mastoidectomy performance. This instrument was further refined into a 14-element checklist focusing on the concept of safety after using it to rate a large and varied population of performances.
SETTING
Twelve otolaryngological surgical training programs in the United States.
PARTICIPANTS
A total of 14 surgeons from 12 different institutions took part in the construction of the instrument.
RESULTS
By using 14 experts from 12 different institutions and a literature review, individual metrics were identified, rated as to the level of importance and operationally defined to create a rating scale for mastoidectomy performance. Initial use of the rating scale showed modest rater agreement. The operational definitions of individual metrics were modified to emphasize "safe" as opposed to "proper" technique. A second rating instrument was developed based on this feedback.
CONCLUSIONS
Using a consensus-building approach with multiple rounds of communication between experts is a feasible way to construct a rating instrument for mastoidectomy. Expert opinion alone using a Delphi method provides face and content validity evidence, however, this is not sufficient to develop a universally acceptable rating instrument. A continued process of development and experimentation to demonstrate evidence for reliability and validity making use of a large population of raters and performances is necessary to achieve universal acceptance.
Topics: Checklist; Clinical Competence; Competency-Based Education; Consensus; Education, Medical, Graduate; Female; Humans; Male; Mastoidectomy; Observer Variation; Otolaryngology; Task Performance and Analysis; United States
PubMed: 28533184
DOI: 10.1016/j.jsurg.2017.05.006 -
Indian Journal of Otolaryngology and... Apr 2023Chronic Otitis Media-Squamosal type is an erosive process, which when confined to ossicular chain causes varying degrees of hearing impairment. As the disease progresses...
Chronic Otitis Media-Squamosal type is an erosive process, which when confined to ossicular chain causes varying degrees of hearing impairment. As the disease progresses to involve surrounding vital structures, it causes various complications like facial palsy, vertigo, mastoid abscess, which are more common than the other intracranial complications, and require a definitive surgical intervention i.e., mastoidectomy at the earliest. A retrospective study on 60 patients who had been operated for squamosal type were analysed for the demographics, symptomatology, intraoperative extent of cholesteatoma, type of mastoidectomy done, various graft materials used for reconstruction, post operatively for graft uptake, hearing improvement and the results were analysed using ChOLE classification of cholesteatoma. Although Intact Canal Wall mastoidectomy had improved post op PTA values, there was no significant difference in the Air-Bone gap closure when Intact Canal Wall mastoidectomy was compared to Canal Wall Down Mastoidectomy.
PubMed: 37206730
DOI: 10.1007/s12070-022-03386-6 -
The Laryngoscope Jul 2013The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Some authorities suggest... (Review)
Review
OBJECTIVES/HYPOTHESIS
The role of mastoidectomy performed with tympanoplasty for tympanic membrane perforations in the absence of cholesteatoma remains controversial. Some authorities suggest that outcomes are improved by the pressure buffering contributed by a well-aerated mastoid. It is unclear, however, whether or not clinical evidence demonstrates a benefit by the addition of a mastoidectomy.
STUDY DESIGN
Review of peer-reviewed publications.
METHODS
The literature on tympanoplasty and mastoidectomy was reviewed, examining the success of tympanic membrane repair, control of drainage, and hearing improvement.
RESULTS
Twenty-six articles were reviewed examining surgical outcomes for patients with perforations resulting from chronic suppurative otitis media without cholesteatoma. Most of the literature consisted of retrospective cohort studies and case series with only a few small prospective randomized trials. Retrospective studies were commonly biased by performing mastoidectomy in ears with worse disease, and methodological differences made comparisons between studies difficult to interpret. There was no evidence of improved outcomes following mastoidectomy compared to tympanoplasty alone. Subgroup analysis, including actively discharging ears, extensive mucosal inflammation, large or repeat perforations, or sclerotic mastoids had overall worse outcomes. These patients showed a nonsignificant trend toward slightly improved results with mastoidectomy.
CONCLUSIONS
The available literature shows no additional benefit to performing mastoidectomy with tympanoplasty for uncomplicated tympanic membrane perforations. Patients with more complicated disease may benefit from the addition of a mastoidectomy, but there is insufficient evidence to make a recommendation for this population. Further prospective controlled studies are needed.
Topics: Humans; Mastoid; Outcome and Process Assessment, Health Care; Tympanic Membrane; Tympanic Membrane Perforation; Tympanoplasty
PubMed: 23686849
DOI: 10.1002/lary.23752 -
The Laryngoscope Dec 1977The long-term results of 375 primary mastoidectomy operations for chronic otitis media and chronic mastoiditis are described and discussed. Two-thirds of these cases...
The long-term results of 375 primary mastoidectomy operations for chronic otitis media and chronic mastoiditis are described and discussed. Two-thirds of these cases were open cavity mastoidectomies and 1/3 closed cavity mastoidectomies. Primary pathology was cholesteatoma in 1/3 and granulation tissue in 2/3 of the cases. The method of reducing the size of the mastoid cavity by sculpturing mastoid cavity by sculpturing mastoid cortical bone is most important in avoiding large postoperative cavity problems. Principles and methods are described. Healing (dry ear) is a more important management objective than hearing and, indeed, enhances the prospects of obtaining a long-term hearing result. Three important phases of controlling mastoid disease (preoperative, operative, and postoperative) are equally stressed. Intact wall tympanomastoidectomy is not recommended in sclerotic mastoids (the majority of our cases) as being unsafe and unnecessary. Revisions, mostly minor, were done in 31% of the cases for a total of 521 procedures. We recomment a one-stage tympanomastoidectomy. Multiple planned procedures are, in the main, unnecessary and should be avoided to reduce unnecessary hospitalization and expense.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cholesteatoma; Ear Diseases; Fascia; Female; Humans; Male; Mastoid; Mastoiditis; Methods; Middle Aged; Otitis Media; Postoperative Complications; Skin Transplantation; Transplantation, Autologous
PubMed: 337011
DOI: 10.1288/00005537-197712000-00001 -
Ear, Nose, & Throat Journal Jun 2023To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy.
OBJECTIVES
To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy.
STUDY DESIGN
Prospective study.
SETTINGS
Tertiary Referral Hospital.
MATERIALS AND METHODS
We analyzed 31 patients with a diagnosis of chronic otitis media with cholesteatoma that extended to the mastoid cavity who underwent endoscopic transcanal retrograde canal wall down mastoidectomy under general anesthesia. The tympanic membrane and posterior canal wall reconstruction were done using the tragal cartilage palisade technique reinforced with perichondrium. Morphological and functional results were reported in the follow-up of a minimum of 1 year. The graft uptake was also compared with the presence of granulations and discharge status.
RESULTS
Graft uptake and disease-free conditions were achieved in 21 of 24 patients, that is, 87.5%, and 3 patients required revision surgery. The graft uptake rate was not affected by the presence of granulation tissues and discharge. The hearing was improved after the surgery, which was statistically significant.
CONCLUSION
Endoscopic retrograde mastoidectomy is a new technique to deal with cholesteatoma with excellent results. It is more functional, ideal for sclerotic mastoid, allows faster wound healing, has excellent outcomes, and is a minimally invasive procedure that avoids postauricular incision and tissue dissection. Because the set up for the surgery costs less, it holds a promising future for the developing countries.
Topics: Humans; Mastoidectomy; Prospective Studies; Cholesteatoma, Middle Ear; Treatment Outcome; Retrospective Studies; Mastoid
PubMed: 33848200
DOI: 10.1177/01455613211009439 -
Otolaryngology--head and Neck Surgery :... Nov 2019Mastoidectomy is a common surgical procedure within otology. Despite being inherently well suited for implementation of robotic assistance, there are no commercially...
Mastoidectomy is a common surgical procedure within otology. Despite being inherently well suited for implementation of robotic assistance, there are no commercially available robotic systems that have demonstrated utility in aiding with this procedure. This article describes a robotic technique for image-guided mastoidectomy with an experimental cooperatively controlled robotic system developed for use within otolaryngology-head and neck surgery. It has the ability to facilitate enhanced operative precision with dampening of tremor in simulated surgical tasks. Its kinematic design is such that the location of the attached surgical instrument is known with a high degree of fidelity at all times. This facilitates image registration and subsequent definition of virtual fixtures, which demarcate surgical workspace boundaries and prevent motion into undesired areas. In this preliminary feasibility study, we demonstrate the clinical utility of this system to facilitate performance of a cortical mastoidectomy by a novice surgeon in 5 identical temporal bone models with a mean time of 221 ± 35 seconds.
Topics: Humans; Mastoidectomy; Microsurgery; Models, Anatomic; Robotic Surgical Procedures; Surgery, Computer-Assisted
PubMed: 31331246
DOI: 10.1177/0194599819861526 -
Otology & Neurotology : Official... Sep 2022Virtual reality (VR) simulation-based training effectively improves novices' mastoidectomy skills. Unfortunately, learning plateaus at an insufficient level and... (Randomized Controlled Trial)
Randomized Controlled Trial
Mastoidectomy Training: Is Anatomical Variation Needed? A Randomized, Controlled Trial on Performance and Skills Transfer From Virtual Reality to a Three-Dimensional Printed Model.
OBJECTIVE
Virtual reality (VR) simulation-based training effectively improves novices' mastoidectomy skills. Unfortunately, learning plateaus at an insufficient level and knowledge on optimizing mastoidectomy training to overcome this plateau is needed. In this study, we aim to investigate how training on anatomically different temporal bone cases affects learning, including the effect on retention and transfer of skills.
STUDY DESIGN
Randomized controlled trial of an educational intervention.
SETTING
The Simulation Center at Copenhagen Academy for Medical Education and Simulation.
PARTICIPANTS
Twenty-four medical students from the University of Copenhagen.
INTERVENTION
Participants were randomized to practice mastoidectomy on either 12 anatomically varying (intervention group) or 12 identical (control group) cases in a VR simulator. At the end of training and again ~ 3 weeks after training (retention), learners were tested on a new VR patient case and a three-dimensional printed model.
MAIN OUTCOME MEASURE
Mastoidectomy performance evaluated by blinded expert raters using a 26-item modified Welling Scale.
RESULTS
The intervention and control groups' performance results were comparable at the end of training. Likewise, retention and transfer performances were similar between groups. The overall mean score at the end of training corresponded to approximately 70% of the possible maximum score.
CONCLUSIONS
Simulation-based training using anatomical variation was equivalent to training on a single case with respect to acquisition, retention, and transfer of mastoidectomy skills. This suggests that efforts to expose novices to variation during initial training are unnecessary as this variation has limited effect, and-conversely-that educators can expose novices to naturally different anatomical variations without worry of hindered learning.
Topics: Clinical Competence; Computer Simulation; Humans; Mastoid; Mastoidectomy; Otolaryngology; Simulation Training; Virtual Reality
PubMed: 35941694
DOI: 10.1097/MAO.0000000000003607 -
International Archives of... Jan 2021Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. To assess the role of...
Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it ( > 0.5). Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets.
PubMed: 33542746
DOI: 10.1055/s-0040-1709196 -
Clinical Otolaryngology : Official... Sep 2021Cortical mastoidectomy is a core skill that Otolaryngology trainees must gain competency in. Automated competency assessments have the potential to reduce assessment...
INTRODUCTION
Cortical mastoidectomy is a core skill that Otolaryngology trainees must gain competency in. Automated competency assessments have the potential to reduce assessment subjectivity and bias, as well as reducing the workload for surgical trainers.
OBJECTIVES
This study aimed to develop and validate an automated competency assessment system for cortical mastoidectomy.
PARTICIPANTS
Data from 60 participants (Group 1) were used to develop and validate an automated competency assessment system for cortical mastoidectomy. Data from 14 other participants (Group 2) were used to test the generalisability of the automated assessment.
DESIGN
Participants drilled cortical mastoidectomies on a virtual reality temporal bone simulator. Procedures were graded by a blinded expert using the previously validated Melbourne Mastoidectomy Scale: a different expert assessed procedures by Groups 1 and 2. Using data from Group 1, simulator metrics were developed to map directly to the individual items of this scale. Metric value thresholds were calculated by comparing automated simulator metric values to expert scores. Binary scores per item were allocated using these thresholds. Validation was performed using random sub-sampling. The generalisability of the method was investigated by performing the automated assessment on mastoidectomies performed by Group 2, and correlating these with scores of a second blinded expert.
RESULTS
The automated binary score compared with the expert score per item had an accuracy, sensitivity and specificity of 0.9450, 0.9547 and 0.9343, respectively, for Group 1; and 0.8614, 0.8579 and 0.8654, respectively, for Group 2. There was a strong correlation between the total scores per participant assigned by the expert and calculated by the automatic assessment method for both Group 1 (r = .9144, P < .0001) and Group 2 (r = .7224, P < .0001).
CONCLUSION
This study outlines a virtual reality-based method of automated assessment of competency in cortical mastoidectomy, which proved comparable to the assessment provided by human experts.
Topics: Adult; Clinical Competence; Education, Medical; Female; Humans; Male; Mastoidectomy; Simulation Training; Virtual Reality
PubMed: 33779051
DOI: 10.1111/coa.13760 -
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