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Cureus Feb 2024There is no global consensus on the surgical technique of cochlear implantation (CI) in ears with an open cavity after canal wall-down (CWD) mastoidectomy. Here, we...
Visual Field Improvement and Electrode Extrusion Prevention by Extended Endaural Incision With Cavity Obliteration for Cochlear Implantation in Ears After Canal Wall-Down Mastoidectomy: Experience of Four Cases.
There is no global consensus on the surgical technique of cochlear implantation (CI) in ears with an open cavity after canal wall-down (CWD) mastoidectomy. Here, we report CI surgery with an endaural incision for the ears after CWD mastoidectomy. The endaural incision was extended upward to obliterate the open cavity of the temporal fascial flap. The endaural incision was extended downward to close the open cavity inlet. After inserting the implanted electrode, the open cavity was obliterated using a temporal fascial flap, and the cavity was closed at the inlet. We performed this type of CI surgery in four ears in three patients. This extended endaural incision provided an excellent view for pedicling the temporal fascial flap with the superficial temporal artery and for open cavity closure without any serious complications. This technique allowed us to opt for CI surgery of the ears after CWD mastoidectomy.
PubMed: 38516473
DOI: 10.7759/cureus.54570 -
The International Tinnitus Journal Mar 2024A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal....
A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Postsurgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure.However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease.
Topics: Adult; Humans; Male; Cholesteatoma, Middle Ear; Chronic Disease; Otitis Media; Retrospective Studies; Treatment Outcome; Tympanic Membrane; Tympanoplasty
PubMed: 38512871
DOI: 10.5935/0946-5448.20230037 -
Otology & Neurotology : Official... Jun 2024To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR)... (Comparative Study)
Comparative Study
OBJECTIVE
To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma.
STUDY DESIGN
Retrospective chart review.
SETTING
Tertiary neurotologic referral center.
PATIENTS
Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty.
INTERVENTIONS
Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration.
MAIN OUTCOME MEASURES
Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates.
RESULTS
Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, -2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03).
CONCLUSIONS
Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon's choice in approach.
Topics: Humans; Male; Female; Retrospective Studies; Middle Aged; Cholesteatoma, Middle Ear; Adult; Mastoid; Mastoidectomy; Treatment Outcome; Tympanoplasty; Postoperative Complications; Plastic Surgery Procedures; Aged; Ear Canal; Young Adult; Audiometry, Pure-Tone; Recurrence
PubMed: 38511274
DOI: 10.1097/MAO.0000000000004172 -
The International Tinnitus Journal Mar 2024External Auditory Canal Cholesteatomas (EACC), is an exceptionally rare condition with a prevalence of only 0.1-0.5% among new patients1. EACC are known to possess bone...
External Auditory Canal Cholesteatomas (EACC), is an exceptionally rare condition with a prevalence of only 0.1-0.5% among new patients1. EACC are known to possess bone eroding properties, causing a variety of complications, similar to the better-known attic cholesteatomas. We describe here the novel surgical management of a case of EACC. She is 38-year-old female who presented with otorrhea for 6 months. Clinical examination and radiological investigations suggested the diagnosis of an external auditory canal cholesteatoma. The patient underwent modified radical mastoidectomy with type 1 tympanoplasty with meatoplasty. Post-operatively, the patient showed marked clinical improvement.
Topics: Female; Humans; Adult; Ear Canal; Retrospective Studies; Cholesteatoma; Ear Diseases; Myringoplasty
PubMed: 38507640
DOI: 10.5935/0946-5448.20230036 -
Cureus Feb 2024Different techniques have been proposed for cochlear implant (CI) from its conventional transmastoid posterior tympanotomy approach. Endoscopy role in the otologic field...
Different techniques have been proposed for cochlear implant (CI) from its conventional transmastoid posterior tympanotomy approach. Endoscopy role in the otologic field is still relatively new, but it provides a better surgical view with improved image clarity, especially in the challenging anatomical visualization of the critical structures in CI surgery. A 3-year-old girl with bilateral progressive profound hearing loss was scheduled for left cochlear implant surgery. The pre-operative high-resolution computed tomography (HRCT) of the temporal bone and magnetic resonance (MR) of internal acoustic meatus reported no significant abnormality of the middle and inner ears structures bilaterally. The standard left postauricular cortical mastoidectomy and posterior tympanotomy were performed. However, the microscopic view could not visualize the round window (RW) niche despite a widened extended posterior tympanotomy and surgical field manipulation. Transfacial recess endoscopic examination was done and was able to identify the possibly atretic RW. With endoscopic guidance, CI electrodes were inserted via cochleostomy, and intraoperative impedance measurement and neural response telemetry were obtained both during surgery and the postoperative phase. No intra- and postoperative complications were observed in this case. Following activation, the CI was functioning well. In conclusion, atretic RW is a rare anomaly found intraoperatively during CI surgery. Endoscope-assisted electrode insertion offers excellent visualization of targeted middle ear structures, especially in limited or abnormal anatomy of RW, which could minimize the risk of surgical complications.
PubMed: 38500948
DOI: 10.7759/cureus.54360 -
Frontiers in Neurology 2024Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior...
OBJECTIVE
Patients with superior canal dehiscence syndrome (SCDS) can present with a plethora of auditory and/or vestibular symptoms associated with a bony defect of the superior semicircular canal. While surgical repair is a reasonable option for patients with significant localizing symptoms, the degree of clinical improvement will vary among patients and poses challenges in outcome prediction. This study aims to assess the relationship between preoperative and postoperative symptoms and identify predictors of symptom persistence following repair.
STUDY DESIGN
Retrospective chart review.
SETTING
Tertiary neurotology single-institution care center.
MAIN OUTCOME MEASURES
The primary outcome was to determine the proportion of resolved and persistent primary (most bothersome) and non-primary audiologic and vestibular symptoms following SCD repair. Secondary outcomes included comparison of patient, operative and radiologic characteristics between patients with resolved vs. persistent symptoms. Standardized patient questionnaires including 11 auditory and 8 vestibular symptoms were administered to patients at their preoperative and follow-up visits. Patient pre- vs. postoperative survey results, demographic and clinical characteristics, operative characteristics, audiometric data and cervical vestibular evoked myogenic potential (cVEMP) thresholds were compared via univariate χ and multivariate binary logistic regression analyses between those patients reporting full postoperative resolution of symptoms and persistence of one or more symptoms. Radiologic computed tomography (CT) measurements of superior canal dehiscence (SCD) defect size, location, and laterality were also compared between these two groups.
RESULTS
Of 126 patients (132 ears) included in our study, 119 patients (90.2%) reported postoperative resolution ( = 82, 62.1%) or improvement ( = 37, 28.0%) of primary (most bothersome) symptoms, while 13 patients (9.8%) reported persistence of primary symptoms. The median (interquartile range) and range between surgery and questionnaire completion were 9 (4-28), 1-124 months, respectively. Analyzing all symptoms (primary and non-primary) 69 (52.3%) and 68 (51.1%) patients reported complete postoperative auditory and vestibular symptom resolution, respectively. The most likely persistent symptoms included imbalance (33/65/67, 50.8%), positional dizziness (7/20, 35.0%) and oscillopsia (44/15, 26.7%). Factors associated with persistent auditory symptoms included history of seizures (0% vs. 7.6%, = 0.023), auditory chief complaint (50.0% vs. 70.5%), higher PTA (mean 19.6 vs. 25.1 dB, = 0.043) and higher cervical vestibular evoked myogenic potential (cVEMP) thresholds at 1000 Hz (mean 66.5 vs. 71.4, = 0.033). A migraine diagnosis (14.0% vs. 41.9% < 0.010), bilateral radiologic SCD (17.5% vs. 38.1%, = 0.034) and revision cases (0.0% vs. 14.0%, = 0.002) were associated with persistent vestibular symptoms. Neither SCD defect size nor location were significantly associated with symptom persistence (P > 0.05).
CONCLUSIONS
Surgical repair for SCDS offers meaningful reduction in the majority of auditory and vestibular symptoms. However, the persistence of certain, mostly non-primary, symptoms and the identification of potential associated factors including migraines, PTA thresholds, cVEMP threshold, bilateral SCD, and revision cases emphasize the importance of individualized patient counseling and management strategies.
PubMed: 38469592
DOI: 10.3389/fneur.2024.1336627 -
Indian Journal of Otolaryngology and... Feb 2024To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the...
To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.
PubMed: 38440657
DOI: 10.1007/s12070-023-04208-z -
Indian Journal of Otolaryngology and... Feb 2024Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft. Mastoidectomy, with or without tympanoplasty, is the preferred treatment...
INTRODUCTION
Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft. Mastoidectomy, with or without tympanoplasty, is the preferred treatment for CSOM. However, the drill used during ear surgery generates noise that may potentially cause hearing damage in both the operated and opposite inner ear, leading to temporary or permanent hearing loss.
MATERIALS AND METHODS
The study included patients diagnosed with CSOM who underwent surgeries in the Otorhinolaryngology department. Postoperatively, all patients were followed up on the 7th day and 1 month after the surgery. Pure Tone Audiometry (PTA) was performed to evaluate the hearing outcomes.
RESULTS
A total of 61 patients were included in the study. The mean preoperative PTA of contralateral ear bone conduction among the study participants was 6.48. At the 7th day post-operation, the mean post-operative PTA of contralateral ear bone conduction for the same participants was 7.77. This difference was statistically significant according to the Paired T-test (P = 0.001).However, when evaluating the mean preoperative PTA of contralateral ear bone conduction (6.48) and the mean post-operative PTA at 1st month (6.02), the difference was not statistically significant (P = 0.208).Additionally, there was no statistical difference in air conduction and air-bone gap before and after surgery.
CONCLUSION
The study suggests that mastoid drilling is associated with a significant temporary hearing loss in the contralateral ear immediately after surgery, which eventually recovers within a month. However, the hearing loss is considered negligible and not statistically significant in the long term. It is worth considering additional audiological investigations, such as otoacoustic emissions, to detect this type of hearing loss more accurately.
PubMed: 38440615
DOI: 10.1007/s12070-023-04129-x -
Indian Journal of Otolaryngology and... Feb 2024Morphometry of pinna may change following ear surgeries. This study gives information about postoperative changes following ear surgeries. This study aims to measure the...
Morphometry of pinna may change following ear surgeries. This study gives information about postoperative changes following ear surgeries. This study aims to measure the variation of ear morphology following surgery and to correlate the type of surgery with post-operative variations. Eighty patients with Chronic Otitis Media(COM) undergoing surgery by post aural approach were grouped into Modified Radical Mastoidectomy (MRM), Cortical Mastoidectomy + Tympanoplasty (CM + TM) and Tympanoplasty groups(TM). The MRM, CM + TM and TM groups had 14, 46 and 20 participants respectively. Various morphometric measurements were taken pre and post operatively. In all groups, the mean Concho-Mastoid Angle (CMA) was increased post operatively, with increase of 11.1 degrees in MRM ( value-0.002), 8.9 degrees in CM + TM (p value-0.000) and 4.8 degrees ( value- 0.657) in TM group. Similarly, the Cepahlo-auricular distances (D1 and D2) showed statistically significant changes in MRM and CM + TM groups ( value < 0.05). Mean CMA of MRM group compared with other groups did not show any statistically significant difference. However, when the CMA of CM + TM group was compared with TM group showed significant difference of 14.53 degree ( value 0.002). Similarly, the D1 and D2 showed statistically significant changes between the CM + TM and TM groups ( value 0.005 and 0.000 respectively). Prominence of pinna following ear surgery is a not a myth. It happens mostly in cases requiring drilling of the mastoid, rather than Tympanoplasty alone. This needs to be explained to the patient beforehand to prevent any confusion post operatively.
PubMed: 38440566
DOI: 10.1007/s12070-023-04214-1 -
Indian Journal of Otolaryngology and... Feb 2024Complete surgical removal of cholesteatoma has been traditionally performed by microscopic approaches. In recent years, use of endoscopes in middle ear surgery is...
UNLABELLED
Complete surgical removal of cholesteatoma has been traditionally performed by microscopic approaches. In recent years, use of endoscopes in middle ear surgery is gaining increasing importance. The wide field view offered by the endoscopes in comparison to the narrow field of view of the binocular microscope enables a surgeon to see and dissect around corners, thereby exposing 'hidden recesses' of the middle ear which can be useful during cholesteatoma surgery. To identify remnant cholesteatoma in difficult access sites of the middle ear cleft using endoscopes following a microscope assisted mastoidectomy. A cross sectional study was conducted in patients who were clinically diagnosed with cholesteatoma. Patients were subjected to High Resolution Computed Tomography of the temporal bone and pre-operative audiological tests. Mastoid exploration was performed microscopically followed by endoscopic evaluation and clearance of disease in the same setting. Patients were then followed up post-operative and endoscopically evaluated to look for any remnant disease. A total of 45 patients were included, all of which underwent microscopic assisted mastoidectomy. Remnant cholesteatoma was discovered in 15 out of 45 cases (33%) distributed in the hidden areas; in the region of sinus tympani 9(60%), anterior epitympanum 4(27%), hypotympanum 1(7%) and tip Cells 1(7%). It can be concluded that endoscopes have a definite role in evaluation and complete surgical clearance of cholesteatoma particularly from the hidden areas of middle ear cleft which would have otherwise been missed by the straight line view of a microscope thereby grossly reducing the rate of remnant disease.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12070-023-04263-6.
PubMed: 38440500
DOI: 10.1007/s12070-023-04263-6