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The Journal of Laryngology and Otology Feb 2024To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition.
OBJECTIVE
To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition.
METHODS
Regional otolaryngology trainees participated in the competition. Drilling activities using the Voxel-Man TempoSurg simulator were scored by experts. Questionnaires that contained questions covering motivators for attending, perceived learning and enjoyment were sent to participants. Agreement with statements was measured on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree).
RESULTS
Eighteen trainees participated. The most cited reason for attending was for learning and/or education (61 per cent), with most attendees (72 per cent) believing that competition encourages more reading and/or practice. Seventeen attendees (94 per cent) believed Voxel-Man TempoSurg-based simulation would help to improve intra-operative performance in mastoidectomy (mean 7.83 ± 1.47, < 0.001) and understanding of anatomy (mean 8.72 ± 1.13, < 0.001). All participants rated the competition as 'fun' and 83 per cent believed the competitive element added to this.
CONCLUSION
The virtual reality temporal bone competition is a novel educational approach within otolaryngology that was positively received by otolaryngology trainees.
PubMed: 38351567
DOI: 10.1017/S0022215124000070 -
European Archives of... May 2024To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition.
OBJECTIVE
To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition.
STUDY DESIGN
A retrospective cohort study.
SETTING
Data based on electronic medical records of the largest Health Maintenance Organization in Israel.
METHODS
Children hospitalized due to acute mastoiditis during the years 2008-2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence.
RESULTS
During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (n = 47) had a single recurrence, whereas 18.5% (n = 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 [(2.7-8.2), p < 0.001] and HR = 2.55 [(1.4-4.8), p = 0.003], respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis.
CONCLUSIONS
Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis.
Topics: Child; Humans; Male; Female; Infant; Mastoiditis; Cohort Studies; Retrospective Studies; Mastoid; Risk Factors; Registries; Acute Disease; Anti-Bacterial Agents
PubMed: 38342819
DOI: 10.1007/s00405-024-08473-8 -
Journal of Clinical Medicine Feb 2024To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children.
OBJECTIVE
To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children.
METHODS
Review of children with primary acquired or congenital cholesteatoma. Severity was classified by extent and EAONO-JOS stage, and surgery by SAMEO-ATO. Primary outcome measure was 5-year recurrence rate using Kaplan-Meier or Cox regression analysis.
RESULTS
Median age was 10.7 years for 408 cholesteatomas from which 64 recurred. Median follow up was 4.6 years (0-13.5 years) with 5-year recurrence rate of 16% and 10-year of 29%. Congenital cholesteatoma (n = 51) had 15% 5-year recurrence. Of 216 pars tensa cholesteatomas, 5-year recurrence was similar at 14%, whereas recurrence from 100 pars flaccida cholesteatomas was more common at 23% (log-rank, = 0.001). Sub-division of EAONO-JOS Stage 2 showed more recurrence in those with than without mastoid cholesteatoma (22.1% versus 10%), with more in Stage 3 (31.9%; = 0.0003). Surgery without mastoidectomy, including totally endoscopic ear surgery, had 11% 5-year recurrence. Canal wall-up tympanomastoidectomy (CWU) and canal wall-down/mastoid obliteration both had 23% 5-year recurrence. Multivariate analysis showed increased recurrence for EAONO-JOS Stage 3 (HR 5.1; CI: 1.4-18.5) at risk syndromes (HR 2.88; 1.1-7.5) and age < 7 years (HR 1.9; 1.1-3.3), but not for surgical category or other factors.
CONCLUSION
Young age and more extensive cholesteatoma increase the risk of recurrent cholesteatoma in children. When controlling for these factors, surgical approach does not have a significant effect on this outcome. Other objectives, such as lower post-operative morbidity and better hearing outcome, may prove to be more appropriate parameters for selecting optimal surgical approach in children.
PubMed: 38337530
DOI: 10.3390/jcm13030836 -
Head & Neck Apr 2024Temporal bone paragangliomas are vascularized neoplasms. Although preoperative angioembolization serves as a valuable approach to reduce intraoperative blood loss, it...
BACKGROUND
Temporal bone paragangliomas are vascularized neoplasms. Although preoperative angioembolization serves as a valuable approach to reduce intraoperative blood loss, it comes with an elevated risk of cranial neuropathies, offers no assurance of complete hemostasis, and precludes real-time adjustments during surgery.
METHODS
A 74-year-old patient presented with recurrent episodes of ear bleeding. On examination, a vascular lesion obstructed her external auditory canal. It had the clinical and radiological characteristics of a paraganglioma. Angiography revealed that it had three feeding vessels.
RESULTS
The patient was successfully scheduled for hybrid, intraoperative angiography and temporary balloon occlusion of the feeding vessels supplying the lesion instead of preoperative angioembolization.
CONCLUSIONS
Utilizing hybrid intraoperative angiography with temporary balloon occlusion during the surgical removal of temporal bone paragangliomas represents an innovative technique that reduces the risk of permanent cranial neuropathies while providing the capacity for real-time adjustments and improved hemostasis.
Topics: Humans; Female; Aged; Paraganglioma; Temporal Bone; Angiography; Balloon Occlusion; Cranial Nerve Diseases
PubMed: 38334158
DOI: 10.1002/hed.27672 -
OTO Open 2024Deconstructing surgeries into steps and providing instructions with illustrations has been the staple of surgical textbooks for decades. However, it may be difficult for...
Deconstructing surgeries into steps and providing instructions with illustrations has been the staple of surgical textbooks for decades. However, it may be difficult for the novice surgeon to interpret 2-dimensional (2D) illustrations into 3D surgeries. The objective of this study is to create operable models that demonstrate the progression of surgery in 3D and allow for mastering the final steps of the operation first. Mastoidectomy was performed in a stepwise fashion to different end points on 5 identical 3D-printed temporal bone models to represent 5 major steps of the operation. The drilled models were computed tomography scanned and the subsequent images were used to create 3D model copies of each step. This is the first study to demonstrate that it is possible to create, scan, and copy stepwise, operable, patient-specific 3D-printed models, which the trainee can both reference as a 3D dissection guide and can operate on repeatedly and in any order.
PubMed: 38333549
DOI: 10.1002/oto2.110 -
International Archives of... Jan 2024Cochlear implantation has been considered as the best treatment in patients with severe to profound hearing loss unaidable with hearing aids. The main value of...
Cochlear implantation has been considered as the best treatment in patients with severe to profound hearing loss unaidable with hearing aids. The main value of endoscope-assisted cochlear implantation is improved visibility of the RW to assess the value of endoscopic assisted CI surgery via facial recess approach without elevating tympanic anulus. This Prospective case series study non-randomized sample was performed on 50 patients with severe to profound hearing loss unaidable with hearing aids undergoing unilateral endoscopic assisted cochlear implant surgery with round window electrode insertion There were 23 male and 27 female patients. Most of the cases were children (41 cases). Of those 50 patients, 39 were prelingually hearing impaired. Four cases had various inner ear abnormalities. The standard mastoidectomy and Posterior Tympanotomy approach were used for all cases. Endoscopic identification of the RW through the PT enabled us to perform regular surgery in all cases. The current study concludes the difference between microscopic exposure and endoscopic exposure represented by Saint Tomas classification found that endoscopic exposure of round window classification is better represented by downgrading in the classification of round window exposure as type I 29(58%), type IIa 18(36%) type IIb 3 (6%) Non were type III by endoscopic exposure compared to microscopic exposure of round window is a type I 7(14%), type II 14(28%), type IIb 22(44%) and type III 7 (14%). Endoscopy proved a great value in exposure and identification of RW in CI surgery through posterior tympanotomy approach.
PubMed: 38322445
DOI: 10.1055/s-0043-1775811 -
The American Journal of Case Reports Feb 2024BACKGROUND With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more...
BACKGROUND With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more uncommon is Gradenigo syndrome (GS), a result of PA, characterized by a triad of otitis media or purulent otorrhea, pain within the regions innervated by the first and second division of the trigeminal nerve, and ipsilateral abducens nerve palsy. Recent literature has demonstrated increasing reports of Fusobacterium necrophorum isolated in cases of GS. CASE REPORT A 21-year-old man presented with otalgia, reduced hearing, and severe headache. Examination revealed right-sided purulent otorrhea, anesthesia within the trigeminal nerve distribution, and an ipsilateral abducens nerve palsy. F. necrophorum was isolated from an ear swab and a blood culture. Computed tomography and magnetic resonance imaging (MRI) demonstrated otomastoiditis, PA, cavernous sinus thrombosis, and severe stenosis of the petrous internal carotid artery. He was treated with intravenous benzylpenicillin, underwent a mastoidectomy and insertion of a ventilation tube, and was started on a 3-month course of dabigatran. Interval MRI showed improved internal carotid artery caliber, persistent petrous apex inflammation, and normal appearance of both cavernous sinuses. Follow-up clinical review noted persistent abducens and trigeminal nerve dysfunction. CONCLUSIONS We identified 190 cases of PA; of these, 80 presented with the classic Gradenigo triad. Fusobacterium sp. were cultured in 10% of GS cases, making them the most frequent isolates. Due to the fastidious nature of F. necrophorum, it may be underrepresented in the historical literature, and we recommend that empiric antibiotics cover anaerobic organisms.
Topics: Male; Humans; Young Adult; Adult; Petrositis; Fusobacterium necrophorum; Otitis Media; Abducens Nerve Diseases; Inflammation; Anti-Bacterial Agents
PubMed: 38319911
DOI: 10.12659/AJCR.942652 -
HNO Mar 2024In 1873, Hermann Schwartze and Adolf Eysell described a new surgical technique for treating mastoid disease using a mallet, chisels, and gouges of various sizes...
BACKGROUND
In 1873, Hermann Schwartze and Adolf Eysell described a new surgical technique for treating mastoid disease using a mallet, chisels, and gouges of various sizes instead of trephines or drill instruments also called "modern mastoidectomy." On the 150th jubilee of this landmark article, we pay tribute by studying the reception and implementation of mastoidectomy in the 2 years following its publication.
METHODS
The commentaries published in the otological and medical literature between the second part of 1873 to the end of 1875 were studied with an emphasis on the three specialized otological journals and the otological textbooks that existed during this period.
RESULTS AND CONCLUSION
The princeps paper Ueber die künstliche Eröffnung des Warzenfortsatzes ("On the artificial opening of the mastoid process") by Hermann Schwartze and Adolf Eysell published in 1873 was rapidly disseminated in the medical literature for nearly 1 year, and then entered a phase of evaluation followed by a phase of extension and implementation, before finding its definitive place in the history of mastoid process surgery.
Topics: Humans; Mastoidectomy; Mastoid; Ear Diseases; Surgical Instruments
PubMed: 38289500
DOI: 10.1007/s00106-023-01418-3 -
HNO Mar 2024
Topics: Mastoidectomy; Mastoid
PubMed: 38289499
DOI: 10.1007/s00106-023-01419-2 -
Cureus Dec 2023Bezold's abscess (BA) is a rare complication of otitis media that presents as a lateral neck abscess below the mastoid tip. BA incidence has recently decreased due to...
Bezold's abscess (BA) is a rare complication of otitis media that presents as a lateral neck abscess below the mastoid tip. BA incidence has recently decreased due to early diagnosis and prompt antibiotic intervention. We present a 42-year-old male with a complicated otitis media developing a 10 cm BA. Treatment of the lesion included surgical drainage and mastoidectomy, accompanied by intravenous (IV) broad-spectrum antibiotic administration. The patient experienced no adverse events during or after surgery and was placed on postoperative observation. However, on postoperative day (POD) 2, the patient left the hospital against medical advice and did not undergo further follow-up.
PubMed: 38288217
DOI: 10.7759/cureus.51298