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Journal of Personalized Medicine Mar 2024Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for...
BACKGROUND
Given that the temporal bone is one of the most complex regions of the human body, cadaveric dissection of this anatomical area represents the first necessary step for the learning and training of the young oto-surgeon in order to perform middle ear surgery, which includes the management of inflammatory pathology, hearing rehabilitation, and also cognitive decline prevention surgery. The primary objective of this study was to identify common mistakes and critical passages during the initial steps of temporal bone dissection, specifically cortical mastoidectomy and posterior tympanotomy.
METHODS
A survey among 100 ENT residents was conducted, gathering insights into the most prevalent errors encountered during their training to uncover the most challenging aspects faced by novice surgeons during these procedures.
RESULTS
The most common mistakes included opening the dura of the middle cranial fossa (MCF), injury of the sigmoid sinus (SS), chorda tympani (CT), and facial nerve (FN) injury while performing the posterior tympanotomy. The most important critical steps to prevent mistakes are related to the absence of wide exposure during cortical mastoidectomy and the consequent impossibility of identifying the landmarks of the facial recess before performing posterior tympanotomy. Injury of these structures was more common in younger surgeons and in the ones who performed less than five temporal bone dissection courses.
CONCLUSIONS
Numerous temporal bone dissections on cadavers are mandatory for ENT residents looking forward to performing middle ear surgery.
PubMed: 38672976
DOI: 10.3390/jpm14040349 -
American Journal of Otolaryngology 2024Acute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage....
INTRODUCTION
Acute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage. Reports show varying preferences for conservative and surgical treatments, with a more conservative approach gaining popularity. In this study we aim to evaluate the presenting symptoms, management and outcomes of patients presenting with intracranial complications secondary to acute mastoiditis.
METHODS
Retrospective review for all children admitted for acute mastoiditis for 12 years period (January 2010-December 2021). Children who had mastoiditis associated with intracranial complications were included in the study. STROBE guidelines were followed in this study.
RESULTS
23 patients were diagnosed with acute mastoiditis with intracranial complications. The mean age was 2.1 years. The most common presenting sign was fever, followed by otalgia. The most common pathogens were Fusobacterium necrophorum and Streptococcus pneumoniae. The most common intracranial complication was sinus vein thrombosis (SVT) affecting 13 patients. Eventually, 10 patients underwent cortical mastoidectomy during 1-6 days upon admission, with an average of 3.2 days. During the follow-up period patients were monitored for clinical progression. Patients who did not show clinical improvement such as persistent fever, worsening symptoms, or the presence of neurological symptoms were treated surgically. The length of stay was an average of 15.5 days overall, with no significantly longer hospital stay in patients who were treated surgically compared to patients who were treated conservatively (17.1 days vs. 14.2 days, P = .26).
CONCLUSION
Intracranial complications of acute mastoiditis remain a significant challenge. Selected patients with intracranial complications can be treated conservatively with close monitoring, without increasing the risk of immediate or long-term complications. Initial antimicrobial treatment should cover anaerobic bacteria, as it correlates with severe complications.
Topics: Humans; Mastoiditis; Male; Female; Child, Preschool; Acute Disease; Retrospective Studies; Child; Infant; Mastoidectomy; Anti-Bacterial Agents; Sinus Thrombosis, Intracranial; Earache; Fever; Length of Stay; Treatment Outcome
PubMed: 38657531
DOI: 10.1016/j.amjoto.2024.104299 -
Clinical Infectious Diseases : An... Apr 2024Otitis is commonly associated with community-acquired bacterial meningitis but role of ear surgery as treatment is debated. In this study, we investigated the impact of...
BACKGROUND
Otitis is commonly associated with community-acquired bacterial meningitis but role of ear surgery as treatment is debated. In this study, we investigated the impact of otitis and ear surgery on outcome of adults with community-acquired bacterial meningitis.
METHODS
We analyzed episodes of adults with community-acquired bacterial meningitis from a nationwide prospective cohort study in the Netherlands, between March 2006 to July 2021.
RESULTS
A total of 2,548 episodes of community-acquired bacterial meningitis were evaluated. Otitis was present in 696 episodes (27%). In these patients the primary causative pathogen was Streptococcus pneumoniae (615 of 696 [88%]), followed by Streptococcus pyogenes (5%) and Haemophilus influenzae (4%). In 519 of 632 otitis episodes (82%) an ear-nose-throat specialist was consulted, and surgery was performed in 287 of 519 (55%). The types of surgery performed were myringotomy with ventilation tube insertion in 110 of 287 episodes (38%), mastoidectomy in 103 of 287 (36%) and myringotomy alone in 74 of 287 (26%). Unfavorable outcome occurred in 210 of 696 episodes (30%) and in 65 of 696 episodes was fatal (9%). Otitis was associated with a favorable outcome in a multivariable analysis (odds ratio 0.74; 95% CI 0.59-0.92; p =0.008). There was no association between outcome and ear surgery.
CONCLUSIONS
Otitis is a common focus of infection in community-acquired bacterial meningitis in adults, with S. pneumoniae being the most common causative pathogen. Presence of otitis is associated with a favorable outcome. Ear surgery's impact on the outcome of otogenic meningitis patients remains uncertain.
PubMed: 38655694
DOI: 10.1093/cid/ciae221 -
European Archives of... Apr 2024The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and...
PURPOSE
The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature.
METHODS
The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty.
RESULTS
In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear.
CONCLUSION
The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.
PubMed: 38642086
DOI: 10.1007/s00405-024-08640-x -
Surgical Neurology International 2024Pediatric penetrating brain injuries (PBIs) are rare but critical traumatic events, often involving foreign objects. This report will emphasize the clinical...
BACKGROUND
Pediatric penetrating brain injuries (PBIs) are rare but critical traumatic events, often involving foreign objects. This report will emphasize the clinical presentation, diagnosis, and treatment strategies for pediatric PBI cases.
CASE DESCRIPTION
This report presents a case of a 7-year-old male patient with a PBI resulting from a nail that penetrated the left mastoid region following a fall from a tree. On admission, the patient maintained consciousness, displayed stable vital signs, and showed no neurological deficits. Crucial radiological examinations, including skull X-rays and head computed tomography (CT) scans, revealed a 6.5 mm caliber nail penetrating 5.5 cm into the brain, with intraventricular hemorrhage filling the bilateral posterior horns of the lateral ventricles. In addition, the CT angiography (CTA) of the head provided a visual of the internal carotid arteries and the vertebrobasilar artery system, obscured by metal artifacts but showing no evidence of thrombus, aneurysm, or vascular malformation. The patient underwent an urgent mastoidectomy and retro sigmoid craniotomy to remove a foreign object, involving a multidisciplinary team. Subsequent to the intervention, the patient sustained full consciousness without neurological impairments and received intensive care.
CONCLUSION
Radiological tools, notably skull X-rays and head CT scans, are pivotal for the precise diagnosis of pediatric PBI. The combined mastoidectomy and retro sigmoid craniotomy approach offers a safe and efficient means of foreign body removal. Tailoring treatments to individual patient needs enhances outcomes.
PubMed: 38628538
DOI: 10.25259/SNI_18_2024 -
Cureus Mar 2024Chronic otitis media (COM) remains a global disease, a burden, and a challenge. Predicting its treatment's postoperative success based on clinical presentation has not...
OBJECTIVES
Chronic otitis media (COM) remains a global disease, a burden, and a challenge. Predicting its treatment's postoperative success based on clinical presentation has not been reported, particularly for the mucosal (tubotympanic/safe) type.
METHODS
A prospective descriptive study of patients with mucosal-type COM was done to identify clinical predictors of improved postoperative hearing outcomes and successful graft uptakes.
RESULTS
Among the 110 ears studied, tympanoplasty was performed in 76 and cortical mastoidectomy with tympanoplasty in 34, based on six weeks of discharge-free or persistent discharge, respectively; all were treated with postoperative intranasal steroid spray. Eustachian tube dysfunction was noted in 96.4%. All patients with a history of ear discharge over five years had ossicular discontinuity, and those with persistent discharge had nonpatent aditus. Normal postoperative hearing was attained in most patients with less than one year of ear discharge. Surgical intervention within a year achieved normal hearing and graft success of 100% with type I tympanoplasty using the fascia alone in discharge-free ears and cortical mastoidectomy with tympanoplasty using cartilage-fascia graft in discharging ears, despite Eustachian tube dysfunction. In the latter group, graft success in type II tympanoplasty was 76.9%.
CONCLUSION
Ear discharge is the prime predictor of postoperative success in mucosal-type COM, as its duration and persistence dictate the time and type of surgical intervention. Duration of more than five years is directly proportional to pre-operative hearing loss with ossicular involvement and inversely proportional to postoperative hearing improvement, necessitating early surgical intervention, despite it being the mucosal or "safe type." Ear discharge-free for six weeks is an indicator of tympanoplasty. Persistent ear discharge, despite nonotogenic confounders, suggests aditus nonpatency, indicates the need for cortical mastoidectomy, and necessitates achieving its patency along with tympanoplasty. A surgical decision-making algorithm for the best possible surgical outcome in the chronic mucosal type of OM is also suggested.
PubMed: 38618356
DOI: 10.7759/cureus.56213 -
OTO Open 2024To describe our modifications to the submental island flap (SMIF) in a case series that demonstrates improved reproducibility, shortened length of stay (LOS), and...
OBJECTIVE
To describe our modifications to the submental island flap (SMIF) in a case series that demonstrates improved reproducibility, shortened length of stay (LOS), and reduced utilization of hospital resources.
STUDY DESIGN
This retrospective case series with chart review included adult patients who underwent resection of malignant or benign tumors resulting in lateral facial, parotid, or temporal bone defects, which were reconstructed with SMIF.
SETTING
A tertiary-care academic referral center.
METHODS
Retrospective case series included all adult patients who underwent SMIF reconstruction between March 2020 and August 2021. Patient demographic and clinical data were collected. Primary outcomes were measures of hospital utilization including duration of surgery, LOS, and postoperative outcomes.
RESULTS
Twenty-eight patients were included with a mean age of 71.7 years. Eighty percent were male. All patients underwent parotidectomy, and the mean operative time was 347 minutes. The median LOS was 2.5 days (range 0-16 days). Seventy-five percent of the flaps drained into the internal jugular vein, and 25% drained into the external jugular vein. No patients required reoperation or readmission. All flaps survived.
CONCLUSION
SMIFs are a safe and effective option for reconstruction of lateral facial, parotid, and temporal bone defects. Compared to free flap reconstruction, SMIFs offer reduced length of surgery, decreased use of health care resources, and lower rate of reoperation. As health care resource allocation is increasingly important, the SMIF offers an excellent alternative to free flap reconstruction of lateral defects.
PubMed: 38618288
DOI: 10.1002/oto2.131 -
The Journal of Laryngology and Otology Apr 2024This study aimed to assess the effect of drilling during mastoidectomy on otolithic organ functions and development of benign paroxysmal positional vertigo using...
OBJECTIVE
This study aimed to assess the effect of drilling during mastoidectomy on otolithic organ functions and development of benign paroxysmal positional vertigo using objective vestibular tests.
MATERIALS AND METHODS
The study included 45 adult patients diagnosed with chronic otitis media who underwent mastoidectomy with drilling. Pre-operative and post-operative assessments included tests for subjective visual vertical deviation and videonystagmography.
RESULTS
Subjective visual vertical deviation was significantly higher in post-operative periods. On the third day, the subjective visual vertical deviation was at its maximum (1.4 degrees). Post-operatively, benign paroxysmal positional vertigo was detected in 14 patients (31.1 per cent). The most common type was ipsilateral lateral canal benign paroxysmal positional vertigo (57.1 per cent).
CONCLUSION
The effect of drilling on otolithic organ functions in mastoidectomy seems to be temporary and subclinical; however, it potentially could be a risk factor for the development of benign paroxysmal positional vertigo.
PubMed: 38606434
DOI: 10.1017/S0022215124000598 -
Acta Cytologica Apr 2024Rhabdomyosarcoma, though rare in the middle ear, necessitates prompt recognition for optimal management. They are malignant mesenchymal neoplasms arising from the...
INTRODUCTION
Rhabdomyosarcoma, though rare in the middle ear, necessitates prompt recognition for optimal management. They are malignant mesenchymal neoplasms arising from the embryonic mesenchymal cells of striated skeletal muscles.
CASE PRESENTATION
We present a case of a 5-year-old child with massive right mastoid swelling and bloody ear discharge. Cytological examination via fine needle aspiration biopsy revealed features suggestive of a malignant mesenchymal tumor, confirmed on imaging and subsequent histopathology as embryonal rhabdomyosarcoma (ERMS) FNCLCC grade 2. Characteristic cytological findings included spindle-shaped cells in a myxoid stroma with tigroid background, aiding in early diagnosis. Despite radical mastoidectomy and adjuvant chemotherapy, ERMS in the middle ear remains challenging due to its aggressive nature and potential complications.
CONCLUSION
This case underscores the importance of cytological evaluation in identifying rare soft tissue tumors like ERMS, facilitating timely intervention and improved outcomes. Early recognition and multidisciplinary management are crucial in addressing the complexities of ERMS in uncommon sites like the middle ear.
PubMed: 38599199
DOI: 10.1159/000538809