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Laryngo- Rhino- Otologie Jul 2023
Topics: Humans; Mastoidectomy; Cholesteatoma
PubMed: 37399815
DOI: 10.1055/a-1987-1910 -
Otology & Neurotology : Official... Jan 2018Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there...
OBJECTIVE
Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there is a significant difference in postoperative complications.
STUDY DESIGN
Retrospective cohort study.
SETTING
American College of Surgeons National Surgical Quality Improvement Program public files.
PATIENTS
Current procedural terminology codes were used to identify patients with chronic ear disease undergoing tympanoplasty ± concurrent mastoidectomy in the 2011 to 14 American College of Surgeons National Surgical Quality Improvement Program files.
INTERVENTION
Therapeutic.
MAIN OUTCOME MEASURES
Variables were compared with χ, Fischer's exact, and Mann-Whitney U tests, as appropriate to analyze postoperative complications between tympanoplasty with or without concurrent mastoidectomy. To account for confounding factors, presence of a complication was analyzed in binary logistic regression. Analysis considered sex, hypertension, obesity, advanced age, diabetes, smoking status, American Society of Anesthesiologists Physical status, procedure.
RESULTS
There were 4,087 patients identified meeting criteria (tympanoplasty = 2,798, tympanomastoidectomy = 1,289). There was no statistical difference in postoperative complications (tympanoplasty n = 49 [1. 8%], tympanomastoidectomy n = 33 [2. 6%]; p = 0. 087) or return to the operating room (tympanoplasty = 4 [0. 1%], tympanomastoidectomy = 6 [0. 5%]; p = 0. 082). Binary logistic regression demonstrated smoking as a predictor of a postoperative complication (OR: 1. 758, 95% CI: 1. 084-2. 851; p = 0. 022), while concurrent mastoidectomy did not significantly increase the risk of complication (OR: 1. 440, 95% CI: 0. 915-2. 268; p = 0. 115). There was a significant difference in mean operative time between tympanoplasty and tympanomastoidectomy: 85.7 versus 154.23 min, p < 0. 001.
CONCLUSION
In the management of chronic ear disease, tympanoplasty with concurrent mastoidectomy increases time under anesthesia, but it is not associated with any increased postoperative complications compared with tympanoplasty alone.
Topics: Adult; Aged; Chronic Disease; Cohort Studies; Ear Diseases; Female; Humans; Male; Mastoidectomy; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 29076928
DOI: 10.1097/MAO.0000000000001609 -
Medicine Feb 2023This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study,...
This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study, we analyzed the main causes of dry ear failure in 43 patients (46 ears) who underwent radical mastoidectomy. We found that inadequate exposure of the mastoid cavity, incomplete removal of pathological tissues, and poor drainage of the surgical cavity were the main reasons for failure of radical mastoidectomy. Lesions in the tympanic ostium of the eustachian tube and incorrect selection of surgical techniques could also cause dry ear failure. Revision surgery based on preoperative temporal bone computed tomography and intraoperative surgical findings could achieve dry ear in 100% of cases and no complications were observed. In patients who underwent tympanoplasty, there was a significant postoperative decrease in the decibel hearing level for the air conduction threshold and air-bone gap ( P < .05). Based on the reasons for failure, the corresponding treatment was undertaken to achieve dry ears during revision surgery.
Topics: Humans; Mastoidectomy; Retrospective Studies; Reoperation; Mastoid; Cholesteatoma, Middle Ear; Treatment Outcome; Chronic Disease
PubMed: 36749232
DOI: 10.1097/MD.0000000000032787 -
Hearing Research Jun 2022In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC... (Review)
Review
In bone conduction (BC) stimulation, the sound travels from the site of stimulation to the ipsilateral and contralateral cochlea. A frequency dependent reduction in BC hearing sensitivity occurs when sound travels to the contralateral cochlea as compared to the ipsilateral cochlea. This effect is called transcranial attenuation (TA) that is affected by several factors. Experimental and clinical studies describe TA and the factors that have an effect on it. These factors include stimulus location, coupling of a bone conduction hearing aid to the underlying tissue, and the properties of the head (such as geometry of the head, thickness of the skin and/or skull, changes due to aging, iatrogenic changes such as bone removal in mastoidectomy, and occlusion of the external auditory canal). While TA has an effect of the patient's benefit of BCHAs, there seems to be a discrepancy between experimental measurements and clinical relevance. The effects are small and the interindividual variability, in comparison, is rather large. However, a better understanding of these factors may help to determine the site of attachment, the coupling mode, and possibly the fitting of a BCHA, depending on its indication.
Topics: Acoustic Stimulation; Bone Conduction; Cochlea; Hearing Aids; Humans; Mastoidectomy; Sound; Vibration
PubMed: 34334219
DOI: 10.1016/j.heares.2021.108318 -
Clinical Otolaryngology : Official... May 2021The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the...
OBJECTIVES
The aim of this study was to examine contamination from otolaryngologic procedures involving high-speed drilling, specifically mastoid surgery, and to assess the adequacy of PPE in such procedures.
DESIGN AND SETTING
Mastoid surgery was simulated in a dry laboratory using a plastic temporal bone, microscope and handheld drill with irrigation and suction. Comparisons of distance of droplet and bone dust contamination and surgeon contamination were made under differing conditions. Irrigation speed, use of microscope and drill burr size and type were compared.
MAIN OUTCOME MEASURES
Measurement of the distance of field contamination while performing simulated mastoidectomy and location of surgeon contamination.
RESULTS
There was a greater distance field contamination and surgeon contamination without the use of the microscope. Contamination was reduced by using a smaller drill burr and by using a diamond burr when compared to a cutting burr. The use of goggles and a face mask provided good protection for the surgeon. However, the microscope alone may provide sufficient protection to negate the need for goggles.
CONCLUSIONS
While the risks of performing mastoid surgery during the coronavirus pandemic cannot be completely removed, they can be mitigated. Such factors include using the microscope for all drilling, using smaller size drill burrs and creating a safe zone around the operating table.
Topics: COVID-19; Dust; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Mastoidectomy; Models, Anatomic; Personal Protective Equipment; Suction; Therapeutic Irrigation
PubMed: 33533176
DOI: 10.1111/coa.13725 -
International Journal of Pediatric... Oct 2023The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of... (Meta-Analysis)
Meta-Analysis
Canal wall up versus canal wall down mastoidectomy techniques in the pediatric population with cholesteatoma: A systematic review and meta-analysis of comparative studies.
IMPORTANCE
The optimal surgical management of cholesteatoma remains controversial. Within pediatric otolaryngology, one of the most vital points of contention is the selection of canal wall-up (CWU) versus canal wall-down (CWD) procedures. Pediatric cholesteatoma has high rates of recurrence (16%-54%). In adults, there is evidence that the selection of surgical techniques affects recurrence rates. This has not been shown in children.
OBJECTIVES
1. To systematically review the literature on recurrent and residual cholesteatoma after CWU and CWD in children and perform a meta-analysis of the data. 2. To assess the rates of recurrent and residual cholesteatoma between CWU and CWD techniques in pediatric patients. 3. To assess hearing outcomes by evaluating postoperative differences in the air-bone gap (ABG) between CWU and CWD techniques.
DATA SOURCES
A systematic search of PubMed, Embase, Scopus, and Cochrane Collaboration was performed from inception to May 1st, 2020, to identify studies that compared CWU and CWD procedures for acquired cholesteatoma in children.
STUDY SELECTION
Search records were screened in duplicate by four reviewers. Inclusion criteria consisted of comparative randomized clinical trials and observational studies assessing outcomes of CWU and CWD techniques in the pediatric population. Studies involving patients with congenital cholesteatoma were excluded.
DATA EXTRACTION AND SYNTHESIS
Four reviewers working independently and in duplicate systematically reviewed and extracted study data. Dichotomous variables were analyzed as risk ratios (RR), while continuous variables were compared using weighted mean differences (MD). The risk of bias was assessed using the CLARITY Scale.
PRIMARY OUTCOMES AND MEASURES
The outcomes were recurrence, residual disease, air-bone gap (ABG), and air conductive (AC) thresholds.
RESULTS
After screening 1036 publications, 17 retrospective cohort studies were selected. 1333 children were included; the overall mean age was ten years (SD 7.9), and the overall mean follow-up time was 5.9 years (SD 6.6). CWU and CWD techniques were performed in 60% (796) and 40% (537) cases. We did not find differences in cholesteatoma recurrence (RR: 1.50, 95% CI 0.94; 2.40; n = 544; I 0%; Tau [2]: 0.00), or rates of residual cholesteatoma (RR 1.51, 95% CI 0.96; 2.38, n = 506; I: 0%; Tau [2]: 0.00) in patients who underwent CWU and CWD mastoidectomy. The mean air-bone gap was lower with CWU than CWD (mean difference: 7.60, 95% CI -10.65; -4.54; n = 242; I: 71%; Tau [2]: 5.98).
CONCLUSION
and relevance: We show similar rates of recurrence and residual disease after either CWU or CWD tympanoplasty. Our results challenge the fundamental principle of CWD surgery as a standard technique, as there is no difference in rates of recurrence and residual disease in CWU and CWD. Moreover, audiometric results support CWU with improved hearing outcomes.
TRIAL REGISTRATION
PROSPERO identifier: CRD42020184029.
Topics: Adult; Humans; Child; Mastoidectomy; Retrospective Studies; Cholesteatoma; Hearing; Odds Ratio
PubMed: 37666040
DOI: 10.1016/j.ijporl.2023.111658 -
International Journal of Audiology Nov 2021Cochlear implantation (CI) is a safe technique to give hearing sensation to a person with hearing impairment. The present study aimed to compare the two surgical...
OBJECTIVE
Cochlear implantation (CI) is a safe technique to give hearing sensation to a person with hearing impairment. The present study aimed to compare the two surgical approaches of CI, mastoidectomy and veria, for their effects on saccular function assessed using cervical vestibular-evoked myogenic potential (cVEMP).
DESIGN
Multiple group time series design.
STUDY SAMPLE
The study included 63 children (3-8 years old) who underwent CI using veria technique ( = 20) and mastoidectomy approach ( = 43). The 500-Hz tone-burst evoked cVEMP were recorded on three occasions- a day before CI surgery, a day after the device switch-on and 4 months after the switch-on.
RESULTS
The post-implant results revealed the absence of cVEMP in nearly 40% of the participants. The amplitudes were significantly lower at the time of the switch-on and at the 4-months follow-up period ( < 0.05). Among the participants undergoing CI using mastoidectomy approach, amplitudes were significantly larger after surgery than those undergoing surgery using veria technique ( < 0.05).
CONCLUSIONS
The saccular responses are better preserved with the mastoidectomy technique than the veria technique for CI surgery.
Topics: Child; Child, Preschool; Cochlear Implantation; Hearing Loss; Hearing Tests; Humans; Mastoidectomy; Vestibular Evoked Myogenic Potentials
PubMed: 33810782
DOI: 10.1080/14992027.2021.1905891 -
Otolaryngologic Clinics of North America Feb 2021Endoscopic ear surgery is increasingly accepted as a primary modality for cholesteatoma surgery. A major advantage is the enhanced visualization of the middle ear in... (Review)
Review
Endoscopic ear surgery is increasingly accepted as a primary modality for cholesteatoma surgery. A major advantage is the enhanced visualization of the middle ear in traditionally poorly accessible locations by the microscope. We discuss novel techniques for selective mastoid obliteration when a canal wall down mastoidectomy is necessary. Postoperatively, indications for non-echo planar diffusion-weighted imaging MRI versus second-look surgery are discussed. Finally, outcome data for endoscopic versus microscopic ear surgery are reviewed, which show equivalent outcomes regarding residual and recurrent disease, similar rates of complications, decreased pain, and shorter healing time.
Topics: Cholesteatoma, Middle Ear; Ear, Middle; Endoscopy; Humans; Magnetic Resonance Imaging; Mastoid; Mastoidectomy; Neoplasm Recurrence, Local; Otologic Surgical Procedures; Postoperative Period; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33131767
DOI: 10.1016/j.otc.2020.09.014 -
JAMA Otolaryngology-- Head & Neck... Jul 2016The ultimate goal of surgical training is consolidated skills with a consistently high performance. However, surgical skills are heterogeneously retained and depend on a...
IMPORTANCE
The ultimate goal of surgical training is consolidated skills with a consistently high performance. However, surgical skills are heterogeneously retained and depend on a variety of factors, including the task, cognitive demands, and organization of practice. Virtual reality (VR) simulation is increasingly being used in surgical skills training, including temporal bone surgery, but there is a gap in knowledge on the retention of mastoidectomy skills after VR simulation training.
OBJECTIVES
To determine the retention of mastoidectomy skills after VR simulation training with distributed and massed practice and to investigate participants' cognitive load during retention procedures.
DESIGN, SETTING, AND PARTICIPANTS
A prospective 3-month follow-up study of a VR simulation trial was conducted from February 6 to September 19, 2014, at an academic teaching hospital among 36 medical students: 19 from a cohort trained with distributed practice and 17 from a cohort trained with massed practice.
INTERVENTIONS
Participants performed 2 virtual mastoidectomies in a VR simulator a mean of 3.2 months (range, 2.4-5.0 months) after completing initial training with 12 repeated procedures. Practice blocks were spaced apart in time (distributed), or all procedures were performed in 1 day (massed).
MAIN OUTCOMES AND MEASURES
Performance of the virtual mastoidectomy as assessed by 2 masked senior otologists using a modified Welling scale, as well as cognitive load as estimated by reaction time to perform a secondary task.
RESULTS
Among 36 participants, mastoidectomy final-product skills were largely retained at 3 months (mean change in score, 0.1 points; P = .89) regardless of practice schedule, but the group trained with massed practice took more time to complete the task. The performance of the massed practice group increased significantly from the first to the second retention procedure (mean change, 1.8 points; P = .001), reflecting that skills were less consolidated. For both groups, increases in reaction times in the secondary task (distributed practice group: mean pretraining relative reaction time, 1.42 [95% CI, 1.37-1.47]; mean end of training relative reaction time, 1.24 [95% CI, 1.16-1.32]; and mean retention relative reaction time, 1.36 [95% CI, 1.30-1.42]; massed practice group: mean pretraining relative reaction time, 1.34 [95% CI, 1.28-1.40]; mean end of training relative reaction time, 1.31 [95% CI, 1.21-1.42]; and mean retention relative reaction time, 1.39 [95% CI, 1.31-1.46]) indicated that cognitive load during the virtual procedures had returned to the pretraining level.
CONCLUSIONS AND RELEVANCE
Mastoidectomy skills acquired under time-distributed practice conditions were retained better than skills acquired under massed practice conditions. Complex psychomotor skills should be regularly reinforced to consolidate both motor and cognitive aspects. Virtual reality simulation training provides the opportunity for such repeated training and should be integrated into training curricula.
Topics: Adult; Denmark; Female; Follow-Up Studies; Humans; Male; Mastoid; Otolaryngology; Prospective Studies; Reaction Time; Retention, Psychology; Simulation Training; Students, Medical
PubMed: 27124506
DOI: 10.1001/jamaoto.2016.0454 -
Computer Methods and Programs in... Sep 2021A simple mastoidectomy is used to remove inflammation of the mastoid cavity and to create a route to the skull base and middle ear. However, due to the complexity and...
A simple mastoidectomy is used to remove inflammation of the mastoid cavity and to create a route to the skull base and middle ear. However, due to the complexity and difficulty of the simple mastoidectomy, implementing robot vision for assisted surgery is a challenge. To overcome this issue using a convolutional neural network architecture in a surgical environment, each surgical instrument and anatomical region must be distinguishable in real time. To meet this condition, we used the latest instance segmentation architecture, YOLACT. In this study, a data set comprising 5,319 extracted frames from 70 simple mastoidectomy surgery videos were used. Six surgical tools and five anatomic regions were identified for the training. The YOLACT-based model in the surgical environment was trained and evaluated for real-time object detection and semantic segmentation. Detection accuracies of surgical tools and anatomic regions were 91.2% and 56.5% in mean average precision, respectively. Additionally, the dice similarity coefficient metric for segmentation of the five anatomic regions was 48.2%. The mean frames per second of this model was 32.3, which is sufficient for real-time robotic applications.
Topics: Humans; Mastoid; Mastoidectomy; Neural Networks, Computer; Robotics; Surgical Instruments
PubMed: 34271262
DOI: 10.1016/j.cmpb.2021.106251