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Otolaryngology--head and Neck Surgery :... Jan 2021To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies.
OBJECTIVE
To investigate small-particle aerosolization from mastoidectomy relevant to potential viral transmission and to test source-control mitigation strategies.
STUDY DESIGN
Cadaveric simulation.
SETTING
Surgical simulation laboratory.
METHODS
An optical particle size spectrometer was used to quantify 1- to 10-µm aerosols 30 cm from mastoid cortex drilling. Two barrier drapes were evaluated: OtoTent1, a drape sheet affixed to the microscope; OtoTent2, a custom-structured drape that enclosed the surgical field with specialized ports.
RESULTS
Mastoid drilling without a barrier drape, with or without an aerosol-scavenging second suction, generated large amounts of 1- to 10-µm particulate. Drilling under OtoTent1 generated a high density of particles when compared with baseline environmental levels ( < .001, = 107). By contrast, when drilling was conducted under OtoTent2, mean particle density remained at baseline. Adding a second suction inside OtoTent1 or OtoTent2 kept particle density at baseline levels. Significant aerosols were released upon removal of OtoTent1 or OtoTent2 despite a 60-second pause before drape removal after drilling ( < .001, = 0, n = 10, 12; < .001, = 2, n = 12, 12, respectively). However, particle density did not increase above baseline when a second suction and a pause before removal were both employed.
CONCLUSIONS
Mastoidectomy without a barrier, even when a second suction was added, generated substantial 1- to 10-µm aerosols. During drilling, large amounts of aerosols above baseline levels were detected with OtoTent1 but not OtoTent2. For both drapes, a second suction was an effective mitigation strategy during drilling. Last, the combination of a second suction and a pause before removal prevented aerosol escape during the removal of either drape.
Topics: Aerosols; COVID-19; Cadaver; Comorbidity; Disease Transmission, Infectious; Ear Diseases; Humans; Mastoid; Mastoidectomy; Otologic Surgical Procedures; Personal Protective Equipment; SARS-CoV-2
PubMed: 32660367
DOI: 10.1177/0194599820941835 -
Otology & Neurotology : Official... Apr 2022Description of a series of cases in which otogenic encephaloceles in patients requiring canal wall down (CWD) mastoidectomies were repaired via a transmastoid approach.
OBJECTIVE
Description of a series of cases in which otogenic encephaloceles in patients requiring canal wall down (CWD) mastoidectomies were repaired via a transmastoid approach.
STUDY DESIGN
Case series.
SETTING
Tertiary-care hospital.
PATIENTS
Eleven cases of otogenic encephaloceles in patients requiring CWD mastoidectomy for chronic ear disease.
INTERVENTIONS
Surgical repair of an otogenic encephalocele using a transmastoid approach.
MAIN OUTCOME MEASURES
Success of repair, number and size of defects, materials used for repair, complications encountered in surgery, pure tone average air-bone gap (PTA-ABG).
RESULTS
Eleven cases were identified. Two of these patients had a prior CWD cavity while the remainder received CWD mastoidectomy simultaneously with encephalocele repair. None of the patients required revision of encephalocele repair. Mean preoperative PTA-ABG was 30 dB and mean postoperative PTA-ABG was 28 dB (p = 0.66).
CONCLUSIONS
A single-stage strictly transmastoid approach to otogenic encephalocele repair may be effective in patients with prior CWD mastoid cavities or requiring concurrent CWD mastoidectomy for chronic ear disease and/or cholesteatoma.
Topics: Cholesteatoma, Middle Ear; Ear Canal; Encephalocele; Humans; Mastoid; Mastoidectomy; Retrospective Studies; Treatment Outcome
PubMed: 35287151
DOI: 10.1097/MAO.0000000000003471 -
BMJ Case Reports Dec 2020
Topics: Child; Cholesteatoma, Middle Ear; Ear Auricle; Humans; Mastoidectomy; Mastoiditis; Tomography, X-Ray Computed
PubMed: 33371002
DOI: 10.1136/bcr-2020-239745 -
Journal of Medical Devices Sep 2015Otologic surgery often involves a mastoidectomy, which is the removal of a portion of the mastoid region of the temporal bone, to safely access the middle and inner ear....
Otologic surgery often involves a mastoidectomy, which is the removal of a portion of the mastoid region of the temporal bone, to safely access the middle and inner ear. The surgery is challenging because many critical structures are embedded within the bone, making them difficult to see and requiring a high level of accuracy with the surgical dissection instrument, a high-speed drill. We propose to automate the mastoidectomy portion of the surgery using a compact, bone-attached robot. The system described in this paper is a milling robot with four degrees-of-freedom (DOF) that is fixed to the patient during surgery using a rigid positioning frame screwed into the surface of the bone. The target volume to be removed is manually identified by the surgeon pre-operatively in a computed tomography (CT) scan and converted to a milling path for the robot. The surgeon attaches the robot to the patient in the operating room and monitors the procedure. Several design considerations are discussed in the paper as well as the proposed surgical workflow. The mean targeting error of the system in free space was measured to be 0.5 mm or less at vital structures. Four mastoidectomies were then performed in cadaveric temporal bones, and the error at the edges of the target volume was measured by registering a postoperative computed tomography (CT) to the pre-operative CT. The mean error along the border of the milled cavity was 0.38 mm, and all critical anatomical structures were preserved.
PubMed: 26336572
DOI: 10.1115/1.4030083 -
Journal of the College of Physicians... Dec 2017To find out the impairment of hearing associated with radical mastoidectomy by measuring the quantitative difference in the functional hearing level before and after... (Comparative Study)
Comparative Study
OBJECTIVE
To find out the impairment of hearing associated with radical mastoidectomy by measuring the quantitative difference in the functional hearing level before and after radical mastoidectomy operation without tympanoplasty.
STUDY DESIGN
Cross-sectional comparative study.
PLACE AND DURATION OF STUDY
Department of Otorhinolaryngology and Head Neck Surgery, Bahawal Victoria Hospital, Bahawalpur and PNS Shifa Hospital, Karachi, from November 2009 to January 2013.
METHODOLOGY
Eighty-five patients, diagnosed clinically as chronic suppurative otitis media with extensive cholesteatoma having history of ear discharge and hearing impairment for more than 6 weeks duration and requiring radical mastoidectomy for treatment, were included in this study. Pure tone audiogram was done before and after radical mastoidectomy. Hearing impairment was compared in each patient before and after the operation.
RESULTS
Among the 85 patients, 54 (63.5%) were males and 31 (36.5%) were females, with the age ranged between 18 to 63 years, mean age being 42.31 4.8 years. The mean increase in hearing loss after radical mastoidectomy in air conduction was 7.19 dB, bone conduction was 4.16 dB, and air-bone gap was 3.75 dB (0.001). The ear became dry and safe in 82 patients (96.5%) out of a total of 85, and only 3 patients required revision surgery at a second stage.
CONCLUSION
Radical mastoidectomy has a least negligible effect on hearing status and one should not limit this technique due to the concern of aggravated hearing in patients with extensive cholesteatoma at the cost of dry and safe ears, which should be of prime importance.
Topics: Adolescent; Adult; Cholesteatoma; Cross-Sectional Studies; Female; Hearing; Hearing Tests; Humans; Male; Mastoid; Mastoidectomy; Middle Aged; Otitis Media, Suppurative; Treatment Outcome; Tympanoplasty; Young Adult
PubMed: 29185402
DOI: No ID Found -
Laryngo- Rhino- Otologie Apr 2020
Topics: Child; Cholesteatoma, Middle Ear; Endoscopy; Humans; Mastoidectomy; Otologic Surgical Procedures
PubMed: 32314333
DOI: 10.1055/a-1107-1240 -
The Annals of Otology, Rhinology, and... Apr 2020Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards...
OBJECTIVE
Competency-based surgical training involves progressive autonomy given to the trainee. This requires systematic and evidence-based assessment with well-defined standards of proficiency. The objective of this study is to develop standards for the cross-institutional mastoidectomy assessment tool to inform decisions regarding whether a resident demonstrates sufficient skill to perform a mastoidectomy with or without supervision.
METHODS
A panel of fellowship-trained content experts in mastoidectomy was surveyed in relation to the 16 items of the assessment tool to determine the skills needed for supervised and unsupervised surgery. We examined the consensus score to investigate the degree of agreement among respondents for each survey item as well as additional analyses to determine whether the reported skill level required for each survey item was significantly different for the supervised versus unsupervised level.
RESULTS
Ten panelists representing different US training programs responded. There was considerable consensus on cut-off scores for each item and trainee level between panelists, with moderate (0.62) to very high (0.95) consensus scores depending on assessment item. Further analyses demonstrated that the difference between supervised and unsupervised skill levels was significantly meaningful for all items. Finally, minimum-passing scores for each item was established.
CONCLUSION
We defined performance standards for the cross-institutional mastoidectomy assessment tool using the Angoff method. These cut-off scores that can be used to determine when trainees can progress from performance under supervision to performance without supervision. This can be used to guide training in a competency-based training curriculum.
Topics: Clinical Competence; Curriculum; Education; Education, Medical, Graduate; Educational Measurement; Humans; Mastoidectomy; Organization and Administration; Otolaryngology; Simulation Training; United States
PubMed: 31731880
DOI: 10.1177/0003489419889376 -
European Archives of... Aug 2022To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment.
PURPOSE
To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment.
METHODS
A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019 in a tertiary care university hospital. 33 patients, divided into 2 groups: 17 patients with sub-periosteal abscess (SPA) alone-single complication group (SCG) and 16 patients with SPA and additional complications: sigmoid sinus thrombosis (SST), peri-sinus fluid/abscess, epidural/subdural abscess, and acute meningitis-multiple complications group (MCG).
RESULTS
33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P = 0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P = 0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings; a total of 18 positive cultures were reported. Fusobacterium necrophorum counted for 8/18(44.5%) of all positive cultures, 7/9(77.8%) in the MCG vs. 1/9(11.1%) in the SCG, P = 0.004. Streptococcus pneumoniae was reported only in SCG (5/9, 55.5%, vs. 0/9, P = 0.008).
CONCLUSION
Post-mastoidectomy fever due to CAM is not unusual and seems to be a benign condition for the first 5-6 days, following surgery. MCG patients are more prone to develop POF. F. necrophorum is more likely to be associated with MCG, and S. pneumoniae is common in SCG patients.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Epidural Abscess; Humans; Infant; Mastoidectomy; Mastoiditis; Retrospective Studies; Streptococcus pneumoniae
PubMed: 34714371
DOI: 10.1007/s00405-021-07149-x -
European Archives of... Nov 2019To evaluate a surgical procedure of canal wall-up mastoidectomy without incision of the canal which enables accelerated healing and enhances hearing outcome.
PURPOSE
To evaluate a surgical procedure of canal wall-up mastoidectomy without incision of the canal which enables accelerated healing and enhances hearing outcome.
METHODS
A total of 79 patients were enrolled. A canal-incisionless technique was used in 37 patients undergoing canal wall-up/down mastoidectomy (CWU/DM), explo-mastoidectomy, and cochlea implantation as staged operation after obliteration of the mastoid, and canal incision was used in the remaining 42 patients as comparison group.
RESULTS
Preoperative and postoperative pure tone audiometry/word recognition score and postoperative status including the healing time and complications were analyzed. Healing time of the canal-incisionless procedure (2.7 weeks) was shorter than that of conventional mastoidectomy with canal incision (5.7 weeks). Complication rate of the canal-incisionless procedure was lower than that of canal incision approach, even though statistical meaningless.
CONCLUSION
Despite the small sample size of our study, in patients undergoing CWDM, explo-mastoidectomy, and cochlea implantation, more acceptable healing was achieved using the canal-incisionless technique than with the canal incision technique. CWU/DM without canal incision is useful to achieve optimal surgical view, eliminate pathology of the middle ear, and accelerate healing time.
Topics: Adult; Aged; Audiometry, Pure-Tone; Ear Canal; Female; Hearing; Humans; Male; Mastoidectomy; Middle Aged; Outcome Assessment, Health Care; Retrospective Studies; Surgical Wound; Time Factors; Wound Healing
PubMed: 31346720
DOI: 10.1007/s00405-019-05578-3 -
Otology & Neurotology : Official... Dec 2021Virtual fixtures can be enforced in cooperative-control robotic mastoidectomies with submillimeter accuracy.
HYPOTHESIS
Virtual fixtures can be enforced in cooperative-control robotic mastoidectomies with submillimeter accuracy.
BACKGROUND
Otologic procedures are well-suited for robotic assistance due to consistent osseous landmarks. We have previously demonstrated the feasibility of cooperative-control robots (CCRs) for mastoidectomy. CCRs manipulate instruments simultaneously with the surgeon, allowing the surgeon to control instruments with robotic augmentation of motion. CCRs can also enforce virtual fixtures, which are safety barriers that prevent motion into undesired locations. Previous studies have validated the ability of CCRs to allow a novice surgeon to safely complete a cortical mastoidectomy. This study provides objective accuracy data for CCR-imposed safety barriers in cortical mastoidectomies.
METHODS
Temporal bone phantoms were registered to a CCR using preoperative computed tomography (CT) imaging. Virtual fixtures were created using 3D Slicer, with 2D planes placed along the external auditory canal, tegmen, and sigmoid, converging on the antrum. Five mastoidectomies were performed by a novice surgeon, moving the drill to the limit of the barriers. Postoperative CT scans were obtained, and Dice coefficients and Hausdorff distances were calculated.
RESULTS
The average modified Hausdorff distance between drilled bone and the preplanned volume was 0.351 ± 0.093 mm. Compared with the preplanned volume of 0.947 cm3, the mean volume of bone removed was 1.045 cm3 (difference of 0.0982 cm3 or 10.36%), with an average Dice coefficient of 0.741 (range, 0.665-0.802).
CONCLUSIONS
CCR virtual fixtures can be enforced with a high degree of accuracy. Future studies will focus on improving accuracy and developing 3D fixtures around relevant surgical anatomy.
Topics: Ear Canal; Humans; Mastoidectomy; Robotic Surgical Procedures; Robotics; Temporal Bone
PubMed: 34325455
DOI: 10.1097/MAO.0000000000003309