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Indian Journal of Otolaryngology and... Apr 2024Chronic Otitis Media (COM) with complications is a common clinical entity in Otorhinolaryngology, but advances in antibiotics and surgical techniques have reduced...
Chronic Otitis Media (COM) with complications is a common clinical entity in Otorhinolaryngology, but advances in antibiotics and surgical techniques have reduced complication rates and mortality. Management warrants surgical disease clearance, the choice of surgical approach of which may vary. Endaural approach is a less commonly performed approach in view of its complexity and surgical expertise. This case report presents a 13-year-old female with COM-squamous active type with cerebellar abscess, managed with Lempert's endaural mastoidectomy. The patient presented with long-standing left sided purulent ear discharge, ear pain, headache, and vomiting. Diagnosis included bilateral COM-squamous active type with left cerebellar abscess, status post suboccipital craniotomy. Endaural mastoidectomy was performed to circumvent the pseudomeningocoele and achieve disease clearance. Postoperative follow-up showed well-healed scars and no evidence of disease recurrence. Chronic Otitis Media with complications requires surgical management to prevent disease progression and related complications. Surgical approaches for disease clearance include post aural and endaural techniques. Lempert's endaural approach provided a superior view of the middle ear and mastoid, facilitating disease clearance and simplifying postoperative care with enhanced cosmesis. Although endaural approach demands surgical expertise, it can be a viable option for complicated cases. In this case, Lempert's endaural canal wall down mastoidectomy effectively managed COM-squamous active type with cerebellar abscess, offering a clear view of the disease epicenter with limited bone removal. The endaural approach, in the hands of an experienced surgeon, can be a feasible alternative for surgical clearance in complicated COM cases, providing favorable outcomes with superior visibility and cosmesis.
PubMed: 38566742
DOI: 10.1007/s12070-023-04365-1 -
Indian Journal of Otolaryngology and... Apr 2024Pulsatile tinnitus (PT) is the perception of an auditory sensation without an external source and in synchrony with the heartbeat. One of the most common cases of PT is...
Pulsatile tinnitus (PT) is the perception of an auditory sensation without an external source and in synchrony with the heartbeat. One of the most common cases of PT is bony anomalies of the sigmoid sinus, including dehiscence or diverticula. This case report describes a 26-year-old female patient who presented with pulsatile tinnitus caused by sigmoid sinus diverticula and dehiscence, which was successfully treated with cortical mastoidectomy with diverticula closure using pedicled temporalis fascia and resurfacing of the dehiscence with autogenous bone pate along with bone cement. We recommend thorough clinical and radiological workup to rule out other possible causes of PT before surgical intervention. In addition, we would like to highlight the surgical technique using pedicled temporalis fascia that we have used in our patient, which is easily reproducible and offers successful outcomes.
PubMed: 38566644
DOI: 10.1007/s12070-023-04410-z -
Scientific Reports Apr 2024Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing...
Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.
Topics: Humans; Mastoidectomy; Printing, Three-Dimensional; Temporal Bone; Simulation Training
PubMed: 38561420
DOI: 10.1038/s41598-024-58359-2 -
American Journal of Otolaryngology 2024To describe a rare complication of cholesteatoma.
OBJECTIVES
To describe a rare complication of cholesteatoma.
METHODS
Case report with literature review.
RESULTS
We report a case of a 37-year-old male who presented for evaluation of otorrhea, headache, and progressive left sensorineural hearing loss. Clinical and radiologic evaluation demonstrated a large recurrent attic cholesteatoma with erosion into the lateral and superior semicircular canals, and diffuse enhancement of the internal auditory canal and cerebellopontine angle suggestive of hypertrophic pachymeningitis secondary to cholesteatoma. After treatment with a course of antibiotics and canal wall down mastoidectomy surgery for cholesteatoma exteriorization, he experienced improvement of his symptoms and resolution of hypertrophic pachymeningitis.
CONCLUSION
Hypertrophic pachymeningitis is a rarely described complication of cholesteatoma. In the context of cholesteatoma, treatment with antibiotics and surgical removal or exteriorization of cholesteatoma are effective treatments for HP.
Topics: Humans; Male; Adult; Meningitis; Cerebellopontine Angle; Cholesteatoma, Middle Ear; Hypertrophy; Recurrence; Ear, Inner; Magnetic Resonance Imaging; Mastoidectomy; Tomography, X-Ray Computed
PubMed: 38547748
DOI: 10.1016/j.amjoto.2024.104263 -
Journal of Clinical Medicine Mar 2024The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not...
The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future.
PubMed: 38542003
DOI: 10.3390/jcm13061780 -
Journal of Clinical Medicine Mar 2024Chronic otitis media affects approximately 2% of the global population, causing significant hearing loss and diminishing the quality of life. However, there is a lack...
Chronic otitis media affects approximately 2% of the global population, causing significant hearing loss and diminishing the quality of life. However, there is a lack of studies focusing on outcome prediction for otitis media patients undergoing canal-wall-down mastoidectomy. This study proposes a recovery prediction model for chronic otitis media patients undergoing canal-wall-down mastoidectomy, utilizing data from 298 patients treated at Korea University Ansan Hospital between March 2007 and August 2020. Various machine learning techniques, including logistic regression, decision tree, random forest, support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (light GBM), were employed. The light GBM model achieved a predictive value (PPV) of 0.6945, the decision tree algorithm showed a sensitivity of 0.7574 and an F1 score of 0.6751, and the light GBM algorithm demonstrated the highest AUC-ROC values of 0.7749 for each model. XGBoost had the most efficient PR-AUC curve, with a value of 0.7196. This study presents the first predictive model for chronic otitis media patients undergoing canal-wall-down mastoidectomy. The findings underscore the potential of machine learning techniques in predicting hearing recovery outcomes in this population, offering valuable insights for personalized treatment strategies and improving patient care.
PubMed: 38541783
DOI: 10.3390/jcm13061557 -
European Archives of... Jun 2024While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down...
BACKGROUND
While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative.
METHODS
Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC.
CONCLUSIONS
The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.
Topics: Humans; Mastoidectomy; Ear Canal; Mastoid; Surgical Flaps; Plastic Surgery Procedures; Male; Female; Adult; Middle Aged
PubMed: 38530458
DOI: 10.1007/s00405-024-08503-5 -
Medical Journal, Armed Forces India 2024The acquisition and refinement of technical skills by the surgical residents are central to surgical teaching; hence, there is increasing interest in the objective...
BACKGROUND
The acquisition and refinement of technical skills by the surgical residents are central to surgical teaching; hence, there is increasing interest in the objective assessment of surgical competence. In the field of otology, as of now, there are limited studies for the assessment of surgical competence, also, various subjective methods are being used to assess this vital aspect of training. This study aimed to validate and use an objective assessment tool for the valuation of surgical skills in a tertiary care teaching institute in the Indian subcontinent.
METHODS
Surgical competence of the residents in temporal bone dissection was assessed on a Likert scale by using a grading scale developed by Wan et al., after obtaining necessary permissions.
RESULTS
Junior residents in ENT who had completed one year of residency in otolaryngology were asked to perform temporal bone surgery (cortical mastoidectomy) and were marked according to the proforma by two senior experienced otologists. The Cronbach's alpha value was .86 which is an indicator of good technical validity.
CONCLUSIONS
In our study, we have validated a grading scoring scale used by Wan et al. to objectively assess the ability of an otology resident to perform temporal bone surgery. It is recommended for use in Indian scenario due to its good technical validity. The use of a Likert scale to individually rate each competency makes the evaluation precise and simple.
PubMed: 38525469
DOI: 10.1016/j.mjafi.2022.08.008 -
Otolaryngology--head and Neck Surgery :... Jun 2024To develop a convolutional neural network-based computer vision model to recognize and track 2 mastoidectomy surgical instruments-the drill and the...
OBJECTIVE
To develop a convolutional neural network-based computer vision model to recognize and track 2 mastoidectomy surgical instruments-the drill and the suction-irrigator-from intraoperative video recordings of mastoidectomies.
STUDY DESIGN
Technological development and model validation.
SETTING
Academic center.
METHODS
Ten 1-minute videos of mastoidectomies done for cochlear implantation by varying levels of resident surgeons were collected. For each video, containing 900 frames, an open-access computer vision annotation tool was used to annotate the drill and suction-irrigator class images with bounding boxes. A mastoidectomy instrument tracking module, which extracts the center coordinates of bounding boxes, was developed using a feature pyramid network and layered with DETECTRON, an open-access faster-region-based convolutional neural network. Eight videos were used to train the model, and 2 videos were used for testing. Outcome measures included Intersection over Union (IoU) ratio, accuracy, and average precision.
RESULTS
For an IoU of 0.5, the mean average precision for the drill was 99% and 86% for the suction-irrigator. The model proved capable of generating maps of drill and suction-irrigator stroke direction and distance for the entirety of each video.
CONCLUSIONS
This computer vision model can identify and track the drill and suction-irrigator from videos of intraoperative mastoidectomies performed by residents with excellent precision. It can now be employed to retrospectively study objective mastoidectomy measures of expert and resident surgeons, such as drill and suction-irrigator stroke concentration, economy of motion, speed, and coordination, setting the stage for characterization of objective expectations for safe and efficient mastoidectomies.
Topics: Humans; Mastoidectomy; Deep Learning; Neural Networks, Computer; Video Recording; Cochlear Implantation; Mastoid; Surgery, Computer-Assisted
PubMed: 38520201
DOI: 10.1002/ohn.733 -
International Journal of Surgery... Mar 2024The microscopic middle ear surgery involves a limited operating space and numerous important anatomical structures in which good visualization is crucial, as even a...
BACKGROUND
The microscopic middle ear surgery involves a limited operating space and numerous important anatomical structures in which good visualization is crucial, as even a small amount of bleeding can greatly affect the clarity of surgical field. This study aims to investigate whether intravenous 1gram of tranexamic acid can improve surgical visualization and further shorten the operation time in microscopic middle ear surgery.
METHODS
This study is a prospective, randomized, double-blind, controlled trial conducted from December 2021 to December 2022, enrolling patients who were scheduled for microscopic modified radical mastoidectomy due to chronic otitis media. In addition to standard techniques to optimize the surgical field, participants were randomized into the TXA (tranexamic acid) group (1gram diluted to 20 mL normal saline) and the control group (20 mL normal saline). The primary outcome was assessed based on the clarity of the surgical field using the Modena Bleeding Score. Secondary outcomes included operation time, the surgeon satisfaction with the visual clarity, postoperative 24-hour coagulation parameters, and the incidence of adverse events. Student's t test, Chi-square test and ANOVA of repeated measures were used for statistical analyses.
RESULTS
A total of 28 patients were enrolled in each group using a 1:1 randomized allocation with similar demographic characteristics, including 24 male and 32 female individuals, and the mean age is 45.6±11.9 years. The surgical visualization in the TXA group was significantly better than that of the control group (2.29±0.46 vs. 2.89±0.31, P<0.001) as assessed by the Modena Bleeding Score. Furthermore, the TXA group demonstrated a shorter operation time compared to the control group (88.61±10.9 vs. 105.2±15.9, P<0.001) and higher surgeon satisfaction with surgical field (7.82±0.55 vs. 6.50±0.64, P<0.001). No statistically significant differences were found in postoperative coagulation parameters in the two groups. No TXA-related adverse events or complications occurred during the 12-month follow-up.
CONCLUSION
Intravenous 1gram of TXA can further significantly improve the visual clarity in the microscopic middle ear surgery and shorten the operation time based on other standard measures implemented.
PubMed: 38518079
DOI: 10.1097/JS9.0000000000001366