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Cureus Aug 2023Actinomycosis is a chronic, indolent, granulomatous disease process caused by the genus of bacteria. More severe forms of actinomycosis include disseminated or central...
Actinomycosis is a chronic, indolent, granulomatous disease process caused by the genus of bacteria. More severe forms of actinomycosis include disseminated or central nervous system (CNS) infections. is the most common species of isolated from brain abscesses. species is commonly associated with skin and soft tissue abscesses. However, it rarely causes brain abscesses. We present an unusual case of brain abscess in a 69-year-old female who presented with acute encephalopathy and bilateral lower extremity weakness. She was diagnosed with left-sided mastoiditis with intracranial extension, left posterior fossa epidural abscess, and transverse sinus thrombosis. The patient's hospital course was complicated by hydrocephalus and declining neurological status. Empiric antimicrobial therapy was initiated, and the patient underwent mastoidectomy and external ventricular drain placement followed by decompression craniotomy and subarachnoid abscess aspiration. Given her poor and unchanged neurologic status, the patient was transitioned to comfort-oriented measures after shared decision-making with the family. It is crucial to identify as a causal agent of severe CNS infections like brain abscesses, meningoencephalitis, or subdural empyema, as untreated infections can lead to irreversible neurologic complications.
PubMed: 37664255
DOI: 10.7759/cureus.42868 -
Asian Journal of Surgery Jan 2024Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for...
OBJECTIVES
Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™.
MATERIALS AND METHODS
This study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection.
RESULTS
The photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy.
CONCLUSIONS
Photopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection.
Topics: Humans; Models, Anatomic; Printing, Three-Dimensional; Temporal Bone
PubMed: 37633781
DOI: 10.1016/j.asjsur.2023.08.095 -
Laryngoscope Investigative... Aug 2023The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration...
OBJECTIVES
The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy.
METHODS
A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups.
RESULTS
The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) ( = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 ( = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups ( > .05).
CONCLUSION
There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy.
LEVEL OF EVIDENCE
1b (individual prospective cohort study).
PubMed: 37621278
DOI: 10.1002/lio2.1096 -
Cureus Jul 2023Neuroendocrine neoplasms (NEN) of the head and neck are a rare and diverse group of tumors. Here, we report a case of a 40-year-old man presenting with symptoms...
Neuroendocrine neoplasms (NEN) of the head and neck are a rare and diverse group of tumors. Here, we report a case of a 40-year-old man presenting with symptoms resembling chronic left otitis media, including left ear otorrhea, otalgia, and reduced hearing. Otoscopic examination revealed a whitish mass located behind the tympanic membrane. The patient underwent examination under anesthesia and left cortical mastoidectomy, and a histopathological examination of the middle ear biopsy indicated the presence of an epithelial tumor with neuroendocrine differentiation, suggestive of middle ear adenoma. A staging CT scan performed three months after the mastoidectomy showed a hypodensity in the middle ear cavity, with no significant bony erosion, which could potentially indicate a residual or recurrent tumor. Consequently, a radical mastoidectomy was performed. The histopathological examination confirmed the presence of middle ear adenoma with neuroendocrine differentiation.
PubMed: 37609079
DOI: 10.7759/cureus.42296 -
Ear, Nose, & Throat Journal Aug 2023To identify the predictors of tympanoplasty success including graft success, hearing outcomes, and recovery time. : Patients who underwent a tympanoplasty between...
To identify the predictors of tympanoplasty success including graft success, hearing outcomes, and recovery time. : Patients who underwent a tympanoplasty between January 2019 and July 2022 were enrolled. Hearing outcomes were measured by air-bone gap from pure tone. Demographic data of the patient, surgical parameters, and Ossiculoplasty Outcome Parameter Staging (OOPS) were reviewed and evaluated to predict the success of tympanoplasty using univariate and multivariate logistic or Cox regression analyzes. : Of 138 patients, 151 procedures were studied. At the 6-month follow-up visit, the overall graft success was 90.7% and the overall hearing success was 40.4%. There was a correlation between the OOPS index and postoperative hearing success (Spearman = 0.322). Blood loss > 10 ml and OOPS ≥ 4 were independent predictors of hearing failure. Blocked aditus ad antrum and blood loss > 10 ml were independent predictors of prolonged recovery time. : The OOPS index exhibits a strong predictive influence on hearing outcomes after tympanoplasty. A predictive model that combines the amount of blood loss and blockage of aditus ad antrum can serve as a useful tool in predicting postoperative recovery time.
PubMed: 37605434
DOI: 10.1177/01455613231194748 -
Ear, Nose, & Throat Journal Aug 2023Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in...
Acquired cholesteatomas behind intact tympanic membrane (ITMC) are rarely encountered in adults in the otology clinic, and the clinical and imaging features of ITMC in adults remain unclear to date. ITMC patients are commonly overlooked because of the absence of both a typical retraction pocket and a tympanic membrane (TM) perforation. The objective of this study was to describe clinical features, pathogenesis, and surgical outcomes in a series of adult patients with acquired ITMC. The clinical records of 13 adult patients diagnosed with ITMC were retrospectively reviewed. ITMC were classified into those associated with otitis media with effusion (OME; Group A) and histories of previous perforations (Group B). A total of 13 cases with unilaterally acquired ITMC were included, of which 10 (76.9%) were in Group A and 3 (23.1%) were in Group B. All Group A patients exhibited white masses behind intact TMs, in the anterosuperior quadrants of 6 and the posterior upper quadrants of 4. In Group B patients, white masses in the middle ear were lacking. The TMs were atrophic and white myringosclerotic plaques were evident. The cholesteatomas were confined to the antrum and aditus ad antrum in 2 Group B patients but extended to the epitympanum in 1. All 10 Group A patients had extensive cholesteatomas but intact (noneroded) malleoli. An acquired ITMC should be suspected if symptoms worsen or new symptoms develop in adults with OME or a history of perforation, although the TM is intact with or without pars flaccida retraction, computed tomography/magnetic resonance imaging should be performed. Canal wall up mastoidectomy combined with ventilation tube insertion effectively treated ITMC associated with OME.
PubMed: 37596947
DOI: 10.1177/01455613231193542 -
Turkish Archives of Otorhinolaryngology Mar 2023This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery.
OBJECTIVE
This study aimed to evaluate the outcomes of total transcanal endoscopic cholesteatoma surgery.
METHODS
Twenty-seven cholesteatoma patients that had undergone transcanal endoscopic ear surgery (TEES) were included in the study. Age, sex, operation date of patients, operated side, need for ossiculoplasty, graft material, and surgical technique were recorded. All patients were evaluated through otoscopic, endoscopic, and audiological examinations and followed up for at least five months after surgery. All patients were staged using the European Academy of Otology and Neurotology/Japan Otological Society (EAONO/JOS) Staging System on Middle Ear Cholesteatoma.
RESULTS
Mean age of the patients was 36.4 years (range, 4-67 years). According to the EAONO/JOS Staging System, 11 patients were stage 1, while 11 were stage 2, and five were stage 3. Two had lateral semicircular canal defect, one had facial canal dehiscence, and one had oval window defect. The average follow-up period was 19 months (range, 5-41 months), during which two patients experienced retraction pocket and hearing loss and one patient had perforation. One patient underwent revision surgery during follow-up and no recurrence or residual cholesteatoma was observed. The preoperative and postoperative air-bone gaps were 25.14±13.93 dB and 22.22±12.64 dB with no significant difference.
CONCLUSION
TEES is a minimally invasive and safe procedure with low complication and recurrence rates. As with all surgical procedures, experience is essential, and as experience increases, the capability to perform endoscopic otologic surgery on more complex cases may become possible.
PubMed: 37583974
DOI: 10.4274/tao.2023.2022-11-6 -
International Archives of... Jul 2023The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region...
The surgical management that achieves minimal morbidity and mortality for patients with glomus and non-glomus tumors involving the jugular foramen (JF) region requires a comprehensive understanding of the complex anatomy, anatomic variability, and pathological anatomy of this region. The aim of this study is to propose a rational guideline to expose and preserve the lower cranial nerves (CNs) in the lateral approach of the JF. The technique utilized is the gross and microdissection of 4 fixed cadaveric heads to revise the JF's surgical anatomy and high part of the carotid sheath compared with surgical cases to understand and preserve the integrity of lower CNs. The method involves radical mastoidectomy, microdissection of the JF, facial nerve, and high neck just below the carotid canal and the JF. The CNs IX, X, XI, and XII are microscopically dissected and kept in sight up to the JF. This study realized well the surgical and applied anatomy of the lower CNs with relation to the facial nerve and JF. The JF anatomy is complicated, and the key to safely operate on it and preserving the lower CNs is to find the posterior belly of the digastric muscle, to skeletonize the facial nerve, to remove the mastoid tip preserving the stylomastoid foramen, to skeletonize the sigmoid sinus and posterior fossa dura not only anterior but also posteroinferior to reach and drill the jugular tubercle.
PubMed: 37564483
DOI: 10.1055/s-0042-1755308 -
International Archives of... Jul 2023The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic...
The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors. To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas. This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypotympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients. The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy. Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.
PubMed: 37564478
DOI: 10.1055/s-0042-1742766 -
Ear, Nose, & Throat Journal Sep 2023We present a case of a 58-year-old male with type II diabetes managed with metformin and insulin, who presented to the clinic with left chronic otitis media, persistent...
We present a case of a 58-year-old male with type II diabetes managed with metformin and insulin, who presented to the clinic with left chronic otitis media, persistent drainage, a stenotic meatus, and a prior history of 3 canal wall-down mastoidectomies and antibiotic therapy. A revision tympanoplasty with mastoidectomy was performed, and during the postoperative period, the patient had persistent pain and otorrhea, which were managed with opioids and several courses of antibiotic therapy. After symptoms persisted, imaging and culture ultimately led to the diagnosis of fungal skull base osteomyelitis, which was eventually treated successfully. While these complications are rare, their likelihood is increased with treatment delay and in the immunocompromised patient. Close management of immunocompromised patients, including diabetic patients, is vital in identifying complications early to aid in timely diagnosis and treatment to lead to the best possible outcome.
Topics: Male; Humans; Middle Aged; Mastoid; Diabetes Mellitus, Type 2; Osteomyelitis; Otitis Media; Anti-Bacterial Agents; Skull Base
PubMed: 37515329
DOI: 10.1177/01455613231189219