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Indian Journal of Otolaryngology and... Jun 2024To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly...
To publish a rare case of Kimura's Disease in Temporal Bone. A 27 year-old male presenting with history of right ear pain and discharge for 2 months was thoroughly evaluated by clinical evaluation, hematological, radiological and histopathological study. Clinical examination revealed a bulge in posterior-inferior quadrant right side of tympanic membrane. HRCT temporal bone revealed a heterogeneous attenuating focal lesion is noted in the region of right middle ear cavity, mastoid antrum mastoid air cells in continuation with the superior aspect of right jugular foramen with erosions and bone destructions, involving the mastoid air cells and sinus plate. Patient was managed surgically with right side canal wall down mastoidectomy and Type 1 Tympanoplasty. Histopathological examination showed focal ulcerated stratified epithelium, dilated elongated congested blood vessels and hemorrhage. Diagnosis was made as Kimura's disease.
PubMed: 38883553
DOI: 10.1007/s12070-023-04454-1 -
International Journal of Pediatric... Jun 2024Incomplete partition type III (IP III) represents a rare malformation of the inner ear, posing challenges during cochlear implantation due to inevitable cerebrospinal...
BACKGROUND
Incomplete partition type III (IP III) represents a rare malformation of the inner ear, posing challenges during cochlear implantation due to inevitable cerebrospinal fluid (CSF) leaks and the potential misplacement of electrodes within the internal auditory canal (IAC). Despite the absence of a consensus on electrode selection, literature suggests both straight and perimodiolar electrodes as viable options for proper insertion. Limited implantation series contribute to the ambiguity in electrode choice. In this study, we evaluated the insertion performance of three electrode types in a 3D model simulating an IP III patient's inner ear.
METHODS
A 3D model replicating the inner ear of a patient with IP III undergoing surgery was created, incorporating a canal wall up mastoidectomy and an enlarged round window approach. Insertions were carried out using a straight electrode, a perimodiolar electrode, and a slim perimodiolar electrode, inserted through a sheath in the basal turn of the cochlea. Electrode positions were assessed after each insertion, with each type being tested 20 times.
RESULTS
Successful insertion rates were 95 % for the slim perimodiolar electrode, 85 % for the perimodiolar electrode, and 75 % for the slim straight electrode. Notably, the slim perimodiolar electrode required an adapted insertion technique due to the altered cochlear position in IP III cases. Statistical analysis revealed the slim perimodiolar electrode's superiority over the slim straight electrode in achieving successful insertions.
CONCLUSIONS
The 3D model of the IP III inner ear proved to be an effective tool for electrode testing and insertion training prior to surgery. Following multiple insertions in the 3D model, the slim perimodiolar electrode demonstrated the highest success rate, emphasizing its potential as the preferred choice for cochlear implantation in IP III cases.
PubMed: 38878450
DOI: 10.1016/j.ijporl.2024.112015 -
The Annals of Otology, Rhinology, and... Jun 2024Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally...
INTRODUCTION
Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis.
METHODS
All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted.
RESULTS
Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management.
CONCLUSION
Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis.
PubMed: 38874209
DOI: 10.1177/00034894241261272 -
The Laryngoscope Jun 2024Pediatric cholesteatoma is an aggressive disease which requires long-term evaluation to assess management strategies. The objective was to determine optimal follow-up...
INTRODUCTION
Pediatric cholesteatoma is an aggressive disease which requires long-term evaluation to assess management strategies. The objective was to determine optimal follow-up duration in pediatric cholesteatoma to detect residual and recurrent diseases.
METHODS
This cohort study was set in a tertiary referral center. All consecutive patients with a minimum 5-year follow-up were included. Medical history, initial extension, surgical procedures, and follow-up were collected. The main outcome measure were Kaplan-Meier survival curves of residual and recurrence cumulative incidence.
RESULTS
Totally 239 ears with the first tympanoplasty between 2008 and 2014 were studied including 25% congenital. At first surgery (S1), mean age was 8.4 years and mean follow-up time 7.9 years. Mastoidectomy was performed in 69% and stapes was absent in 38% of cases. Notably, 83% (199 ears) had a second procedure (S2) of which 186 were planned. After S1, maximum cumulated incidence of residual was 45% [95%CI, 38%; 52%] at 74 months, with probability of residual of 39% at 3 years. After S2 (n = 199), maximum cumulated residual incidence was 21% [95%CI, 12%; 32%] at 62 months and 16% at 3 years. Concerning recurrence, maximum cumulated incidence after S1 (n = 239) was reached at 98 months with 21% [95%CI, 12%; 32%], 13% at 3 years and 16% at 5 years. Congenital disease had significantly less residuals after S1 (p = 0.02), but similar recurrence rate (p = 0.66) compared with acquired.
CONCLUSIONS AND RELEVANCE
We recommend MRI follow-up of at least 5 years after the last surgery for residual disease and clinical follow-up of at least 10 years to detect recurrence.
LEVEL OF EVIDENCE
4 Laryngoscope, 2024.
PubMed: 38855882
DOI: 10.1002/lary.31567 -
Folia Morphologica Jun 2024Considering the tortuous course of the facial canal that houses the facial nerve, the stylomastoid artery and the homonymous vein, its morphological features are of...
BACKGROUND
Considering the tortuous course of the facial canal that houses the facial nerve, the stylomastoid artery and the homonymous vein, its morphological features are of great clinical significance in otologic, maxillofacial, oncologic, reconstructive and plastic surgery of the head and neck. The aim of this paper was to determine the individual specific features of the mastoid segment of facial canal and of the stylomastoid foramen.
MATERIAL AND METHODS
The study was carried out on 82 temporal bones (41 right/41 left), at the Department of anatomy and clinical anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova. The morphometry of the mastoid segment of the facial canal and of the stylomastoid foramen was performed. The morphometric parameters were statistically analyzed by descriptive and inferential statistics methods.
RESULTS
The mastoid segment exited the facial canal by an obtuse, right and sharp angles, with a mean value of 113.1 ± 21.80° (right/left - 112.1 ± 23.85°/114.1 ± 19.76°), p = 0.701. The mean length of the mastoid segment was 15.1 ± 3.78 mm (right/left - 15.7 ± 3.66 mm/14.5 ± 3.84 mm), p = 0.153. The longitudinal diameter of the stylomastoid foramen had a mean of 3.0 ± 0.93 mm (right/left - 3.3 ± 0.96 mm/2.7 ± 0.81 mm), p = 0.007. The transverse diameter had a mean of 2.6 ± 0.74 mm (right/left - 2.9 ± 0.80 mm/2.4 ± 0.60 mm), p = 0.012.
CONCLUSIONS
In otologic surgery and particularly in mastoidectomy, it should be taken into consideration that the mastoid segment of the facial canal could exit the temporal bone by a sharp, right and obtuse angles that along with high morphological variability of the stylomastoid foramen might be a predisposal factor for Bell's palsy.
PubMed: 38842075
DOI: 10.5603/fm.100260 -
International Journal of Computer... May 2024Skullbase surgery demands exceptional precision when removing bone in the lateral skull base. Robotic assistance can alleviate the effect of human sensory-motor...
PURPOSE
Skullbase surgery demands exceptional precision when removing bone in the lateral skull base. Robotic assistance can alleviate the effect of human sensory-motor limitations. However, the stiffness and inertia of the robot can significantly impact the surgeon's perception and control of the tool-to-tissue interaction forces.
METHODS
We present a situational-aware, force control technique aimed at regulating interaction forces during robot-assisted skullbase drilling. The contextual interaction information derived from the digital twin environment is used to enhance sensory perception and suppress undesired high forces.
RESULTS
To validate our approach, we conducted initial feasibility experiments involving a medical and two engineering students. The experiment focused on further drilling around critical structures following cortical mastoidectomy. The experiment results demonstrate that robotic assistance coupled with our proposed control scheme effectively limited undesired interaction forces when compared to robotic assistance without the proposed force control.
CONCLUSIONS
The proposed force control techniques show promise in significantly reducing undesired interaction forces during robot-assisted skullbase surgery. These findings contribute to the ongoing efforts to enhance surgical precision and safety in complex procedures involving the lateral skull base.
PubMed: 38816649
DOI: 10.1007/s11548-024-03168-1 -
BMJ Open May 2024Radical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the...
Efficacy and safety of intravenous tranexamic acid in microscopic modified radical mastoidectomy: a study protocol for a prospective, randomised, double-blind controlled trial.
INTRODUCTION
Radical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the clarity of the operative field. Our trial is designed to investigate whether the intravenous administration of tranexamic acid (TXA) can improve the clarity of the operative field, reduce the operative time, and increase surgeon satisfaction.
METHODS AND ANALYSIS
This study is a prospective, randomised, double-blinded, controlled trial that aims to investigate the effects of TXA on patients with otitis media. The trial will include patients between the ages of 18 and 65 who will be randomly assigned to either the TXA group or the control group. In the TXA group, patients will receive 1 g of TXA diluted to 20 mL of normal saline before anaesthesia induction while the control group will receive 20 mL of normal saline. The primary outcome measure will be the Modena Bleeding Score, which will assess the clarity of the surgical field. Secondary outcomes will include the surgeon's satisfaction with surgical conditions, operation time, laboratory measurements (prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer) and levels of inflammatory factors (such as IL-6) at 24 hours postoperatively. In addition, the incidence of general adverse reactions such as postoperative nausea, vomiting and dizziness; serious adverse events such as arterial and venous thromboembolism, myocardial infarction and epilepsy within 90 days will be compared between the two groups.
ETHICS AND DISSEMINATION
The protocol was approved by the Ethics Committee of Peking University People's Hospital (2021PHB173-001), on 19 July 2021. The trial results will be submitted for publication in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
ChiCTR2100049183.
Topics: Humans; Tranexamic Acid; Double-Blind Method; Antifibrinolytic Agents; Prospective Studies; Adult; Administration, Intravenous; Mastoidectomy; Middle Aged; Female; Male; Adolescent; Otitis Media, Suppurative; Young Adult; Randomized Controlled Trials as Topic; Operative Time; Aged
PubMed: 38806427
DOI: 10.1136/bmjopen-2024-087062 -
International Journal of Pediatric... Jun 2024Pandemic public health measures, such as masks and social distancing, present unique challenges for people who are hard-of-hearing. This study sought to understand how...
BACKGROUND
Pandemic public health measures, such as masks and social distancing, present unique challenges for people who are hard-of-hearing. This study sought to understand how adolescents with varying levels of hearing loss would describe their experiences communicating in a classroom environment during a pandemic and its associated public health measures.
METHODS
Qualitative study utilizing one-on-one semi-structured interviews conducted from July 2021 to April 2022. Interviews were transcribed and analyzed using a reflexive thematic analysis to conceptualize the main themes from the data. Adolescents ages 12-17 who attended school in person during the COVID-19 pandemic with either normal hearing or; bilateral cochlear implants or; bone-anchored hearing aids or; unilateral moderate to severe (40-70 dB) conductive hearing loss secondary to mastoidectomy, were interviewed. Participants were recruited from BC Children's Hospital Otolaryngology clinic via a convenience sample.
RESULTS
Fourteen adolescents were interviewed with a median age of 15, 9 with hearing loss and 5 with normal hearing. Pandemic associated challenges such as masks muffling speech, protocol fatigue, and missing pre-pandemic life were present in both the hearing loss and normal hearing groups. Classroom communication for adolescents with hearing loss was disproportionately affected by pandemic measures, leading to challenges making friends, feeling behind their peers in learning, and listening fatigue. Resilience was noted among adolescents with hearing loss in their ability to adapt to pandemic measures and changing classroom dynamics. For adolescents with unilateral hearing loss, the pandemic provided an improved listening environment via a reduction in background noise.
CONCLUSION
Pre-existing classroom communication challenges for adolescents with hearing loss were amplified under pandemic public health measures and shared, in part, by those with normal hearing. These findings can be used to further inform classroom design to the optimize learning environment for deaf and hard of hearing students.
Topics: Humans; Adolescent; COVID-19; Male; Female; Qualitative Research; Child; Communication; SARS-CoV-2; Hearing Loss; Pandemics; Schools; Cochlear Implants; Masks; Hearing Aids; Interviews as Topic
PubMed: 38805933
DOI: 10.1016/j.ijporl.2024.111989 -
Journal of Personalized Medicine Apr 2024Spontaneous orbital cephaloceles are a rare condition. The purpose of this study is to provide a description of a clinical case and to carry out a systematic literature... (Review)
Review
BACKGROUND
Spontaneous orbital cephaloceles are a rare condition. The purpose of this study is to provide a description of a clinical case and to carry out a systematic literature review.
METHODS
A systematic review of the English literature published on the Pubmed, Scopus, and Web of Science databases was conducted, according to the PRISMA recommendations.
RESULTS
A 6-year-old patient was admitted for right otomastoiditis and thrombosis of the sigmoid and transverse sinuses, as well as the proximal portion of the internal jugular vein. Radiological examinations revealed a left orbital mass (22 × 14 mm) compatible with asymptomatic orbital meningocele (MC) herniated from the superior orbital fissure (SOF). The child underwent a right mastoidectomy. After the development of symptoms and signs of intracranial hypertension (ICH), endovascular thrombectomy and transverse sinus stenting were performed, with improvement of the clinical conditions and reduction of the orbital MC. The systematic literature review encompassed 29 publications on 43 patients with spontaneous orbital MC. In the majority of cases, surgery was the preferred treatment.
CONCLUSIONS
The present case report and systematic review highlight the importance of ICH investigation and a pathophysiological-oriented treatment approach. The experiences described in the literature are limited, making the collection of additional data paramount.
PubMed: 38793047
DOI: 10.3390/jpm14050465 -
Journal of Clinical Medicine May 2024The development of temporal bone pneumatization is related to the postnatal middle ear environment, where the development of air cells is suppressed with otitis media...
The development of temporal bone pneumatization is related to the postnatal middle ear environment, where the development of air cells is suppressed with otitis media in early childhood. However, whether air cell formation restarts when mastoidectomy is performed during temporal bone pneumatization remains unclear. Herein, we evaluated temporal bone pneumatization after canal wall up (CWU) tympanomastoidectomy for middle ear cholesteatoma in children. In total, 63 patients, including 29 patients with congenital cholesteatoma (CC) and 34 patients with acquired cholesteatoma (AC), were assessed using a set of pre- and postoperative computed tomography images. The air cells of the temporal bone were divided into five areas: periantral (anterior), periantral (posterior), periantral (medial), peritubal, and petrous apex. The number of areas with air cells before and after surgery was compared to evaluate temporal bone pneumatization after surgery. A total of 63 patients, comprising 29 with CC and 34 with AC (pars flaccida; 23, pars tensa; 7, unclassified; 4), were evaluated. The median age of patients (18 males and 11 females) with CC was 5.0 (range, 2-15 years), while that of the AC group (23 males and 11 females) was 8 (range, 2-15 years). A significant difference in air cell presence was identified in the CC and AC groups after surgery (Mann-Whitney U, < 0.001 and = 0.003, respectively). Between the two groups, considerably better postoperative pneumatization was observed in the CC group. A correlation between age at surgery and gain of postoperative air cell area development was identified in the CC group (Spearman's rank-order correlation coefficient, r = -0.584, < 0.001). In comparison with the postoperative pneumatization rate of each classified area, the petrous apex area was the lowest in the CC and AC groups. Newly developed air cells were identified in the temporal bones after CWU mastoidectomy for pediatric cholesteatoma. These findings may justify CWU tympanomastoidectomy, at least for younger children and CC patients, who may subsequently develop air cell systems after surgery.
PubMed: 38792475
DOI: 10.3390/jcm13102934