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Otology & Neurotology : Official... Sep 2022This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to compare surgical and audiometric outcomes of tympanoplasty alone (T) to tympanoplasty and mastoidectomy (T&M) in patients without cholesteatoma.
DATABASES REVIEWED
According to PRISMA guidelines, English articles in PubMed, Scopus, CINAHL, and Cochrane Library databases from inception to 7/29/2021 were searched.
METHODS
Studies describing a comparison of patients who underwent T to patients who underwent T&M were included. Studies describing patients with cholesteatoma were excluded. Patient demographics, graft failure rates, and preoperative and postoperative audiological findings were collected. Mean differences (MD) and risk difference (RD) were calculated using RevMan 5.4. Heterogeneity was assessed using Q test and I2 statistic. Risk of bias was assessed using both version 2 of the Cochrane risk-of-bias tool for randomized trials and Risk of Bias in Non-randomized Studies of Interventions.
RESULTS
A total of 27 studies fulfilled eligibility with T (n = 1,711) and T&M (n = 1,186). When pooling the data, mean differences between T versus T&M for air bone gap (-0.3 dB: 95% CI = -1.9 to 1.3, p = 0.730) and pure tone average (1.9 dB: 95% CI = -0.3 to 4.2, p = 0.090) were not statistically significant. Graft failure was higher with T only (16.4% versus 14.2%) than T&M (RD = -0.04, 95% CI = -0.07 to -0.00, p = 0.030, I2 = 35%].
CONCLUSION
This study endorses clinically similar audiological outcomes and a reduced risk difference of graft failure with mastoidectomy. Although these data suggest that adding a mastoidectomy could decrease the risk of graft failure, the risk reduction is minimal. More research on the cost-effectiveness and the specific patient clinical characteristics and comorbidities that would benefit from adding a mastoidectomy is warranted.
Topics: Cholesteatoma; Cholesteatoma, Middle Ear; Chronic Disease; Humans; Mastoid; Mastoidectomy; Otitis Media; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 35970151
DOI: 10.1097/MAO.0000000000003631 -
European Annals of Otorhinolaryngology,... Nov 2022Systematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21 century.
OBJECTIVES
Systematic review of the scientific literature dedicated to treatment modalities and results for aural tuberculosis published since the start of the 21 century.
MATERIAL AND METHODS
Search of the Medline, Cochrane and Embase databases for the period 2000 - 2020. Selection of articles in English, French and Spanish devoted to clinical cases and series documenting treatment of auricular tuberculosis. Extraction of data on pre-established files documenting treatment modalities and results. Reading of articles by two authors. Analysis performed according to SWiM guidelines, evaluating cure, tuberculosis-related death, treatment-related complications, improvement in facial palsy, and hearing sequelae rates.
RESULTS
One hundred and twenty eight articles: 118 case reports (159 patients) and 10 cohorts (177 patients) from 42 countries were analyzed. Female/male sex ratio was 1.2 with ages ranging from 1 month to 87 years. Medical treatment consisted in 5 to 24 months' antitubercular antibiotic treatment using 2 to 8 antibiotics. Mastoidectomy, tympanoplasty and facial nerve decompression were associated to medical treatment in 64.7%, 17.4% and 6.2% of cases, respectively. Overall rates of cure, death, treatment-related complications, facial sequelae and hearing sequelae were 96.8%, 2%, 9.5%, 35.8% and 75.5%. In case reports, BCG vaccination did not appear to protect against facial palsy and severe intracranial complications (P>0.6). There was no significant correlation (P>0.3) between death and the clinical variables tested, and facial nerve decompression did not appear to influence outcome for facial function (P=0.4).
CONCLUSION
Medical treatment is very effective but not without risk of death, complications and sequelae. It is the same as for pulmonary tuberculosis. Indications for and benefit of major auricular surgery during medical treatment deserve further studies.
Topics: Humans; Male; Female; Facial Paralysis; Tuberculosis; Facial Nerve; Bell Palsy; Tympanoplasty; Anti-Bacterial Agents
PubMed: 35778340
DOI: 10.1016/j.anorl.2022.06.007 -
Clinical Otolaryngology : Official... Nov 2022To review the role of the endoscope in cochlear implantation (CI). (Review)
Review
OBJECTIVE
To review the role of the endoscope in cochlear implantation (CI).
METHODS
MEDLINE, ScienceDirect, Google Scholar and the Cochrane Library databases, as well as other sources, were searched by two independent reviewers. Studies including patients undergoing either exclusively endoscopic or endoscopically assisted CI were eligible for inclusion. Endoscopic CI approaches and postoperative complications were the primary outcomes. Secondary endpoints included the degree of round window (RW) microscopic visualisation according to St Thomas' Hospital classification and type of cochleostomy for electrode insertion in the scala tympani (ST).
RESULTS
Fourteen studies met the inclusion criteria comprising 191 endoscopic or endoscopically assisted CI cases. The endoscope was used for better visualisation of the RW across all included studies, facilitated the insertion of the electrode in the ST and spared a mastoidectomy in a number of cases. No facial nerve palsy was reported in any of the studies. The most common complication was external auditory canal/tympanic membrane tear followed by chorda tympani injury.
CONCLUSION
The microscopic CI approach is still the gold standard. The endoscope facilitates the recognition of the RW area and leads to successful and safe implantation, particularly in difficult anatomical scenarios, ear malformations and advanced otosclerosis. Endoscopically assisted CI procedures offer the opportunity to avoid a posterior tympanotomy and reduce the risk of facial nerve injury. To date, the lack of long-term data does not permit the widespread adoption of completely endoscopic CI procedures without a mastoidectomy.
Topics: Cochlear Implantation; Cochlear Implants; Endoscopes; Humans; Round Window, Ear; Scala Tympani
PubMed: 34971491
DOI: 10.1111/coa.13909 -
Cureus Oct 2021Our objective is to analyze the risk of particle spread through mastoidectomy during the COVID-19 pandemic with an aim to assess the tools used to mitigate the... (Review)
Review
Our objective is to analyze the risk of particle spread through mastoidectomy during the COVID-19 pandemic with an aim to assess the tools used to mitigate the spread. A systematic review was conducted using PRISMA guidelines. Our search terms included: MASTOIDECTOMY + COVID-19 or MASTOIDECTOMY + SAR- CoV-2 or MASTOIDECTOMY + CORONAVIRUS. Studies consistent with the inclusion and exclusion criteria were included in the review. Of the 20 articles identified in the initial search, six met the inclusion criteria. The included articles were all experimental studies, with five studies using cadaver subjects and one study using live human subjects. Three studies measured droplet spread and three studies measured aerosolized particle spread. The maximum distance of particle spread ranged from 30 cm to 208 cm. Four studies assessed the use of a barrier system, with two using the OtoTent and two using a barrier drape. Two studies defined the microscope alone as a possible mitigatory tool. One study compared burr type and size to determine the effects on particle spread. During the coronavirus disease 2019 (COVID-19) pandemic, evaluation of tools to mitigate particle spread is imperative for the safety of the surgical team and the healthcare system at large. Barrier drapes, OtoTents and microscopes all have proven to mitigate particle spread; however, further research needs to be performed to compare their efficacy and develop a standard of safety.
PubMed: 34853757
DOI: 10.7759/cureus.19040 -
The Journal of Laryngology and Otology Oct 2022Epithelial migration has been associated with the self-cleansing mechanism of the ear. The rate and pattern of epithelial migration in healthy and pathological ears are... (Review)
Review
BACKGROUND
Epithelial migration has been associated with the self-cleansing mechanism of the ear. The rate and pattern of epithelial migration in healthy and pathological ears are reviewed.
METHODS
Two authors independently screened articles over one month using the following search terms: epithelial migration, epithelial, tympanic membrane, external auditory canal and mastoidectomy cavity.
RESULTS
Ten studies were included. The fastest rate of epithelial migration was observed in the external auditory canal, with a mean of 144.75 μm per day, whereas the slowest epithelial migration was seen in post-mastoidectomy cavities, with a rate of 20 μm per day. Epithelial migration was present in both studies involving post-mastoidectomy cavities.
CONCLUSION
Epithelial migration is faster in healthy tympanic membrane than in pathological tympanic membrane. The rate of epithelial migration in the external auditory canal was higher in the pathological group than in the healthy group. Epithelial migration is present in post-mastoidectomy cavities.
Topics: Ear Canal; Humans; Mastoid; Tympanic Membrane
PubMed: 34725011
DOI: 10.1017/S0022215121003376 -
The Journal of Laryngology and Otology Aug 2021Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the...
OBJECTIVE
Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media.
METHOD
A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted.
RESULTS
From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application.
CONCLUSION
Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.
Topics: Cholesteatoma, Middle Ear; Ear, Middle; Humans; Mesna; Otitis Media; Protective Agents
PubMed: 34219630
DOI: 10.1017/S0022215121001535 -
The Annals of Otology, Rhinology, and... Dec 2021To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available...
OBJECTIVES
To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae.
METHODS
A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl's fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl's fissures.
RESULTS
An 11-year-old female was referred for recurrent meningitis. Imaging demonstrated a fistulous connection between the middle ear and IAC diverticulum via the jugular foramen. Specifically, a Hyrtl's fissure was identified, as well as demineralized bone around the jugular bulb. Obliteration of the fissure was initially performed, and a fistula reformed 4 months later. Multifocal CSF egress in the hypotympanum was identified on re-exploration, and middle ear obliteration with external auditory canal (EAC) overclosure was performed. A systematic review of the literature demonstrated 19 cases of spontaneous congenital perilabyrinthine CSF leaks. In total, 6 cases had multiple sources of CSF leak and 2 had history suggestive of intracranial hypertension. All of these noted cases demonstrated leak recurrence. Middle ear obliteration with EAC overclosure was successful in 4 recalcitrant cases.
CONCLUSIONS
Repair of spontaneous congenital perilabyrinthine CSF leaks in cases demonstrating multiple sources of egress or signs of intracranial hypertension should be approached with caution. Middle ear obliteration with EAC overclosure may provide the most definitive management option for these patients, particularly if initial attempt at primary repair is unsuccessful.
Topics: Cerebrospinal Fluid Otorrhea; Child; Ear, Inner; Female; Fistula; Humans; Mastoidectomy; Skull Base; Tomography, X-Ray Computed; Tympanic Membrane
PubMed: 33834882
DOI: 10.1177/00034894211007242 -
Journal of Otology Dec 2020Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively. Their role at present is more as adjunct... (Review)
Review
Endoscopes are increasingly being used in cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively. Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy. However, as endoscopy and endoscopic instruments are increasingly getting refined, role of endoscopy in management of cholesteatoma is continuously being appraised with progressively newer studies. This review aims to assess outcomes of several studies in which endoscopic techniques were used in cholesteatoma surgery and recognize common trends. An extensive review of literature on this theme was performed. Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included. Intra-operatively, in 267 (15.82%) cases, residual cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope. On follow-up, recidivism was identified in 108 cases (6.4%) in second look procedures. Common sites of recurrence were hidden areas like sinus tympani. This review while acknowledging the value of microscope, highlights the merit of endoscope usage in cholesteatoma surgery and its role in reducing recurrence.
PubMed: 33293919
DOI: 10.1016/j.joto.2020.06.004 -
International Journal of Pediatric... Oct 2020To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures.
OBJECTIVE
To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures.
METHOD
We conducted a search of MEDLINE/PubMed for articles published through January 2020 utilizing the following terms: Grisel's syndrome, Grisel syndrome, and atlantoaxial subluxation alone and in combination with other terms like ENT, otolaryngology, head & neck, tonsillectomy, adenoidectomy, adenotonsillectomy, mastoidectomy, tympanoplasty, and tympanomastoidectomy. We included English-language cases that occurred after surgical procedures and contained the following data: age, onset, common presenting symptoms, diagnostic approach, management options, and the presence of complications.
RESULT
We found 39 papers that met our criteria. Most cases occurred after adenotonsillectomy with or without ventilation tube insertion (55.6%). The majority of the affected population was the pediatric age group, and the main presenting symptom was torticollis that presents as early-onset. In regard to management, most of the cases were treated with medical therapy with or without adjunctive measures (e.g., a cervical collar). No neurological complications were recorded except in one case that was treated with no long term sequel.
CONCLUSION
Grisel's syndrome is a rare complication that occurs after otolaryngology procedures and can result in serious neurological complications and death. A high index of suspicion is an important factor for early diagnosis and management to prevent such complications. In most cases, conservative management is successful with a good prognosis.
Topics: Atlanto-Axial Joint; Humans; Joint Dislocations; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Syndrome; Torticollis; Treatment Outcome
PubMed: 32658805
DOI: 10.1016/j.ijporl.2020.110225 -
Auris, Nasus, Larynx Apr 2020Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to...
OBJECTIVES
Luc's abscess is a rare complication of acute otitis media, with a challenging diagnosis and a controversial surgical treatment. The aim of the present study was to review the published literature in order to clarify the clinical features and the surgical management of those patients.
METHODS
A systematic review of the literature was carried out for published reports or case series in English language, describing a temporo-zygomatic (or Luc's) abscess which complicated an acute or chronic otitis media and/or mastoiditis, confirmed through CT scan or MRI of the petrous bone. The collected clinical and radiological data were merged and critically appraised.
RESULTS
Eighteen reports of Luc's abscess were included. Adding our case report, a total of 21 cases were included in the analysis. Abscess drainage plus myringotomy alone vs. abscess drainage plus myringotomy and mastoidectomy were the two surgical management approaches described in the literature. Patients undergoing first line mastoidectomy were successfully treated in all cases, while among those undergoing a more conservative approach, one failure required subsequent mastoidectomy.
CONCLUSIONS
The clinical features of Luc's abscess are rather constant and help in rising the suspicion before the radiological diagnosis. Although cases with associated intra-cranic complications have been reported, the limited existing data do not permit to advocate the mastoidectomy over a more conservative surgical approach. However, the decision to avoid mastoidectomy as the first line surgical treatment should be based on the clinical and radiologic assessment, after an accurate counseling, particularly in the case of a pediatric patient.
Topics: Abscess; Anti-Bacterial Agents; Drainage; Edema; Erythema; Eyelids; Female; Humans; Infant; Mastoidectomy; Mastoiditis; Middle Ear Ventilation; Otitis Media; Temporal Bone; Tomography, X-Ray Computed; Zygoma
PubMed: 31812444
DOI: 10.1016/j.anl.2019.11.003