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European Archives of... Mar 2019To investigate validity evidence, and strengths and limitations of performance metrics in mastoidectomy training.
OBJECTIVE
To investigate validity evidence, and strengths and limitations of performance metrics in mastoidectomy training.
METHODS
A systematic review following the PRISMA guidelines. Studies reporting performance metrics in mastoidectomy/temporal bone surgery were included. Data on design, outcomes, and results were extracted by two reviewers. Validity evidence according to Messick's framework and level of evidence were assessed.
RESULTS
The search yielded a total of 1085 studies from the years 1947-2018 and 35 studies were included for full data extraction after abstract and full-text screening. 33 different metrics on mastoidectomy performance were identified and ranked according to the number of reports. Most of the 33 metrics identified had some amount of validity evidence. The metrics with most validity evidence were related to drilling time, volume drilled per time, force applied near vital structures, and volume removed.
CONCLUSIONS
This review provides an overview of current metrics of mastoidectomy performance, their validity, strengths and limitations, and identifies the gap in validity evidence of some metrics. Evidence-based metrics can be used for performance assessment in temporal bone surgery and for providing integrated and automated feedback in virtual reality simulation training. The use of such metrics in simulation-based mastoidectomy training can potentially address some of the limitations in current temporal bone skill assessment and ease assessment in repeated practice. However, at present, an automated feedback based on metrics in VR simulation does not have sufficient empirical basis and has not been generally accepted for use in training and certification.
LEVEL OF EVIDENCE
2a.
Topics: Clinical Competence; Humans; Mastoid; Mastoidectomy; Otologic Surgical Procedures; Simulation Training; Temporal Bone
PubMed: 30604063
DOI: 10.1007/s00405-018-05265-9 -
Laryngo- Rhino- Otologie Jul 2023
Topics: Humans; Mastoidectomy; Cholesteatoma
PubMed: 37399816
DOI: 10.1055/a-1987-2064 -
Ear, Nose, & Throat Journal Oct 2023To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea.
OBJECTIVES
To evaluate the effectiveness of mastoidectomy with antibiotic catheter irrigation in patients with chronic tympanostomy tube otorrhea.
METHODS
A chart review of adult and pediatric patients with persistent tympanostomy tube otorrhea who had failed outpatient medical management and underwent mastoidectomy with placement of a temporary indwelling catheter for antibiotic instillation was performed. Patients were retrospectively followed for recurrent drainage after 2 months and outcomes were categorized as resolution (0-1 episodes of otorrhea or otitis media with effusion during follow-up), improvement (2-3 episodes), or continued episodic (>3 episodes).
RESULTS
There were 22 patients and 23 operated ears. Median age was 46 years (interquartile range, IQR = 29-65). The median duration of otorrhea from referral was 5.5 months (IQR = 2.8-12). Following surgery, 14 ears had resolution of drainage, 6 had improvement, and 3 had episodic. The observed percentage of resolved/improved ears (87%) was significant ( = .0005, 95% CI = 67.9%-95.5%). Median follow-up time was 25 months (IQR = 12-59). Pre and postoperative pure tone averages improved (difference of medians = -3.3 dB, = .02) with no significant difference in word recognition scores ( = .68). Methicillin-resistant was the most common isolated microbe while no growth was most frequently noted on intraoperative cultures.
CONCLUSIONS
Mastoidectomy with antibiotic catheter irrigation may be an effective surgical strategy, and single stage alternative to intravenous antibiotics, for select patients with persistent tube otorrhea who have failed topical and oral antibiotics.
Topics: Adult; Aged; Humans; Middle Aged; Anti-Bacterial Agents; Catheters; Drainage; Ear Diseases; Mastoidectomy; Methicillin-Resistant Staphylococcus aureus; Middle Ear Ventilation; Otitis Media with Effusion; Retrospective Studies
PubMed: 34130511
DOI: 10.1177/01455613211025742 -
European Archives of... May 2017The objective of the present paper was to acquire information about the mastoidectomy size necessary to obtain an optimal placement of the direct acoustic cochlear...
The objective of the present paper was to acquire information about the mastoidectomy size necessary to obtain an optimal placement of the direct acoustic cochlear implant actuator and fixation system. Ten human cadaveric temporal bones were dissected and implanted with direct acoustic cochlear implant. Mastoidectomy size was determined after implantation in each temporal bone. A bone bed for the receiver/stimulator, mastoidectomy and a large posterior tympanotomy were drilled out. The mastoidectomy was progressively enlarged posteriorly in small steps until the actuator template was judged adequately oriented to enable passage of the rod through the posterior tympanotomy without any contact with the bony walls. The distance between different landmarks in the mastoidectomy was measured. All measured values showed a high degree of consistency, with limited median absolute deviation values. One of the most critical measure, i.e. the distance between the posterior margin of the mastoidectomy to the superior rim of the bony external ear canal wall, ranged from 13 to 16 mm with a median value of 15 mm. Prior knowledge of the ideal size of the mastoidectomy for direct acoustic cochlear implant facilitates the positioning of the fixation system and may save time during implant surgery.
Topics: Cochlear Implantation; Cochlear Implants; Humans; Mastoid; Models, Anatomic; Organ Size; Prosthesis Retention; Temporal Bone
PubMed: 28246895
DOI: 10.1007/s00405-017-4504-0 -
American Journal of Otolaryngology 2020To develop a time-sensitive, standardized rubric for cadaveric temporal bone dissection for otolaryngology resident education.
OBJECTIVE
To develop a time-sensitive, standardized rubric for cadaveric temporal bone dissection for otolaryngology resident education.
METHODS
This is a five-year prospective cohort study that evaluated otolaryngology resident performance during sequential cadaveric temporal bone dissection courses at a single otolaryngology residency training program. A canal-wall-up mastoidectomy with a facial recess approach was performed adhering to a 30-minute time limit and graded according to a standardized rubric. Main outcome measures included: (1) correct structure identification and (2) injuries sustained to structures as compared by resident post-graduate year (PGY) level.
RESULTS
Thirteen residents were evaluated from October 2012 to March 2017. This included 57 individual graded exercises performed over ten dissection courses. The average score for PGY-2 residents was lowest (68.9), and PGY-5 residents achieved the highest average score (87.7). Junior residents correctly identified fewer structures (77.5%) when compared to senior residents (91.3%), p < 0.0001. Correct performance of a facial recess approach was achieved by 100% of senior residents, but only 59.3% of junior residents (p = 0.0003). The percentage of major injuries, which included the facial nerve, tegmen, labyrinth, and ossicular chain, decreased each PGY-level from a maximum of 17% by PGY-2 residents to a minimum of 5% by PGY-5 residents.
CONCLUSION
Senior residents correctly identify more structures and are able to complete a facial recess approach with higher fidelity when subjected to a time-sensitive graded mastoidectomy rubric.
Topics: Cadaver; Cohort Studies; Education, Medical, Graduate; Humans; Internship and Residency; Mastoidectomy; Otolaryngology; Prospective Studies; Simulation Training; Temporal Bone; Time Factors
PubMed: 32247707
DOI: 10.1016/j.amjoto.2020.102457 -
American Journal of Otolaryngology 2020To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU)... (Comparative Study)
Comparative Study
INTRODUCTION
To evaluate perioperative costs of canal wall-down (CWD) mastoidectomy as an initial surgery compared to revision surgery following initial canal wall-up (CWU) mastoidectomy.
METHODS
This study is a retrospective chart review of adult patients who underwent CWD mastoidectomy for chronic otitis media with or without cholesteatoma at a tertiary referral center. Patients were divided into groups that had previous CWU surgery and were undergoing revision CWD and those that were having an initial CWD mastoidectomy. Cost variables including previous surgeries, imaging costs, audiometric testing, and post-operative visits were compared between the two groups using t-test analysis.
RESULTS
There was no significant difference with regards to the cost of post-operative visits, peri-operative imaging, or revision surgeries between the two groups. Hearing outcomes based on mean speech reception threshold (SRT) were not statistically different between the two groups (p = 0.087). There was a significant difference in total cost with the revision group having a higher mean cost by $6967.84, most of which was accounted for by the difference in the cost of the previous surgeries of $6488.53.
CONCLUSIONS
The revision CWD surgery group had increased total cost that could be attributed to the cost of previous surgery. Increased peri-operative cost was not noted with the initial CWD surgery group for any individual variables examined. Initial CWD mastoidectomy should be considered in the proper patient population to help decrease healthcare costs.
Topics: Adolescent; Adult; Aged; Audiometry; Cholesteatoma; Chronic Disease; Cost Savings; Costs and Cost Analysis; Diagnostic Imaging; Female; Humans; Male; Mastoidectomy; Middle Aged; Office Visits; Otitis Media; Perioperative Period; Postoperative Care; Reoperation; Retrospective Studies; Young Adult
PubMed: 32971408
DOI: 10.1016/j.amjoto.2020.102733 -
Acta Otorrinolaringologica Espanola 1998The controversy regarding the best procedure for treating middle ear cholesteatoma has lasted over 100 years. This paper discusses our current methods for dealing with... (Comparative Study)
Comparative Study
UNLABELLED
The controversy regarding the best procedure for treating middle ear cholesteatoma has lasted over 100 years. This paper discusses our current methods for dealing with cholesteatoma, always through external ear or transmeatal mastoidectomy. We present the results of three years of follow-up.
MATERIAL AND METHODS
A prospective study was made of 215 ears operated for cholesteatoma using a transcanal approach with one of three techniques: "on demand" DAA mastoidectomy, modified radical mastoidectomy, and radical mastoidectomy with obliteration. Three parameters were used to evaluate results: stability of the mastoid cavity, integrity of the neotympanum, and evolution of hearing.
RESULTS
The rate of cholesteatoma recurrence in ears operated with these techniques was much lower than that found in canal-wall-up techniques. Only 3 of the 215 cases (1.4%) remained unstable due to different causes three years after surgery.
DISCUSSION AND CONCLUSIONS
Due to the high rate of cholesteatoma recurrence, canal-wall-up mastoidectomy has been abandoned in our clinic. Open techniques using a transmeatal approach, with or without obliteration, and the so-called "on demand" mastoidectomy, have yielded more stable results, although postoperative care is more critical.
Topics: Cholesteatoma, Middle Ear; Evaluation Studies as Topic; Follow-Up Studies; Humans; Mastoid; Otolaryngology; Postoperative Complications; Prospective Studies; Recurrence
PubMed: 9717321
DOI: No ID Found -
Journal of Neurosurgery Mar 2020The presigmoid approach (PSA) is selected to obtain more lateral access to cerebellopontine angle tumors, brainstem cavernous malformations, or vertebrobasilar artery...
The presigmoid approach (PSA) is selected to obtain more lateral access to cerebellopontine angle tumors, brainstem cavernous malformations, or vertebrobasilar artery aneurysms than the standard retrosigmoid approach. However, mastoidectomy for the PSA can be considered time-consuming and to carry a higher risk of complications due to the anatomical complexity of the region. The authors established a method of minimized mastoidectomy focused on exposing Trautmann's triangle as the corridor for the PSA while maximizing procedural simplicity and safety and maintaining a sufficient operative view. The authors present their method of minimized mastoidectomy in a cadaver dissection and operative cases, showing potential as a useful option for the PSA.
Topics: Abducens Nerve Diseases; Adult; Aged; Cadaver; Cerebellar Neoplasms; Cerebellopontine Angle; Ear, Inner; Epidermal Cyst; Female; Humans; Intracranial Arteriovenous Malformations; Magnetic Resonance Imaging; Mastoid; Mastoidectomy; Neurosurgical Procedures; Patient Positioning; Skull Base; Vertebrobasilar Insufficiency
PubMed: 32217804
DOI: 10.3171/2020.1.JNS193179 -
World Neurosurgery Oct 2022Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a...
BACKGROUND
Mastoidectomy involves drilling the temporal bone while avoiding the facial nerve, semicircular canals, sigmoid sinus, and tegmen. Optical topographic imaging (OTI) is a novel registration technique that allows rapid registration with minimal navigational error. To date, no studies have examined the use of OTI in skull-base procedures.
METHODS
In this cadaveric study, 8 mastoidectomies were performed in 2 groups-4 free-hand (FH) and 4 OTI-assisted mastoidectomies. Registration accuracy for OTI navigation was quantified with root mean square (RMS) and target registration error (TRE). Procedural time, percent of mastoid resected, and the proximity of the mastoidectomy cavity to critical structures were determined.
RESULTS
The average RMS and TRE associated with OTI-based registration were 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. The volume removed, expressed as a percentage of the total mastoid volume, was 37.5% (±10.2%) versus 31.2% (±2.3%), P = 0.31, for FH and OTI-assisted mastoidectomy. There were no statistically significant differences between FH and OTI-assisted mastoidectomies with respect to proximity to critical structures or procedural time.
CONCLUSIONS
This work is the first examining the application of OTI neuronavigation in lateral skull-base procedures. This pilot study revealed the RMS and TRE for OTI-based navigation in the lateral skull base are 1.44 mm (±0.83 mm) and 2.17 mm (±0.89 mm), respectively. This pilot study demonstrates that an OTI-based system is sufficiently accurate and may address barriers to widespread adoption of navigation for lateral skull-base procedures.
Topics: Humans; Mastoid; Mastoidectomy; Neuronavigation; Pilot Projects; Skull Base; Surgery, Computer-Assisted
PubMed: 35953033
DOI: 10.1016/j.wneu.2022.07.150 -
Acta Oto-laryngologica Feb 2009Successful canal wall down (CWD) mastoidectomy requires removal of all diseased air cells, lowering of the facial ridge to the mastoid segment of the facial nerve,...
CONCLUSIONS
Successful canal wall down (CWD) mastoidectomy requires removal of all diseased air cells, lowering of the facial ridge to the mastoid segment of the facial nerve, complete removal of the lateral epitympanic wall, and amputation of the mastoid tip. Additionally, the inferior canal wall should be lowered to adequately expose the hypotympanum, which allows a smooth transition into the mastoid cavity. An adequate meatoplasty is also necessary. Closed supratubal recess should be opened, anulus and tympanic membrane remnant should be removed in CWD cases. Revision mastoidectomy has a high success rate in obtaining a dry and epithelialized ear.
OBJECTIVE
This study reports revision mastoidectomy results and indicates factors that must receive attention in chronic otitis media surgery to produce less revision surgery.
PATIENTS AND METHODS
Thirty-five patients who underwent revision mastoidectomy with or without cholesteatoma between 2005 and 2008 were analyzed retrospectively. Patients who had revision mastoidectomy with previous intact canal wall (ICW) or CWD mastoidectomies were included in the study.
RESULTS
Patients were aged 32-69 years (mean 57.4). There were 22 female and 13 male patients. Revision mastoidectomies were applied to 14 previous ICW and 21 prior CWD mastoidectomies. Of the 35 patients, 24 patients had cholesteatoma and 11 of them did not. Of the patients who had revision surgery, 10 had ICW mastoidectomy and 25 had CWD mastoidectomy. After revision mastoidectomy, at 3-25 months follow-up (mean 16.7 months), 29 patients had been successfully treated; they had dry well epithelialized cavity, with no findings of persistent, recurrent discharge or granulation tissue and cholesteatoma. In 21 patients in whom revision CWD mastoidectomy was performed, causes of failure of previous ear surgery in order of frequency were recurrent or persistent cholesteatoma and narrow meatoplasty (80.9%), persistent sinodural angle air cells and close supratubal recess (71.4%), high facial ridge and inadequate canalplasty (66.7%), persistent tegmental air cells and tympanic membrane remnant (57.1%), persistent mastoid apex air cells and open eustachian orifice (52.4%). Causes of failure after our revision ICW mastoidectomy in order of frequency were persistent or recurrent cholesteatoma (78.6%), closed supratubal recess (64.3%), persistent sinodural angle air cells, inadequate canalplasty and persistent mastoid apex air cells (57.1%), persistent tegmental air cells (42.9%).
Topics: Adult; Aged; Cholesteatoma, Middle Ear; Chronic Disease; Ear Canal; Eustachian Tube; Female; Humans; Male; Mastoid; Middle Aged; Otitis Media; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Tympanic Membrane
PubMed: 18607914
DOI: 10.1080/00016480802140893