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The Cochrane Database of Systematic... Feb 2013This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2010.Ménière's disease is characterised by three major symptoms: vertigo,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 2010.Ménière's disease is characterised by three major symptoms: vertigo, deafness, and tinnitus or aural fullness, all of which are discontinuous and variable in intensity. A number of surgical modalities, of varying levels of invasiveness, have been developed to reduce the symptoms of Ménière's disease, but it is not clear whether or not these are effective.
OBJECTIVES
To assess the effectiveness of surgical options for the treatment of Ménière's disease. All surgical interventions used in the treatment of Ménière's disease, either to alter the natural history of the disease or to abolish vestibular function, were considered for this review.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 7 November 2012.
SELECTION CRITERIA
Randomised or quasi-randomised controlled studies of a surgical modality versus a placebo therapy in Ménière's disease.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We contacted study authors for further information.
MAIN RESULTS
The only surgical intervention which has been evaluated in randomised controlled trials and met the inclusion criteria was endolymphatic sac surgery. We identified two randomised trials, involving a total of 59 patients; one comparing endolymphatic sac surgery with ventilation tubes and one with simple mastoidectomy. Neither study reported any beneficial effect of surgery either in comparison to placebo surgery or grommet insertion.
AUTHORS' CONCLUSIONS
The two trials included in this review provide insufficient evidence of the beneficial effect of endolymphatic sac surgery in Ménière's disease.
Topics: Endolymphatic Sac; Humans; Mastoid; Meniere Disease; Middle Ear Ventilation; Randomized Controlled Trials as Topic
PubMed: 23450562
DOI: 10.1002/14651858.CD005395.pub3 -
The Journal of International Advanced... Dec 2019Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of... (Review)
Review
Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the main techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. The materials used for this reason are either biological or synthetic. The purpose of this survey is to review the published literature related to the therapeutic value of mastoid obliteration with synthetic materials. We searched Web of Science, PubMed, and MEDLINE from 2008 to 2018 using the criteria mastoid obliteration, canal wall down mastoidectomy, chronic otitis media, and cholesteatoma. The search focused on papers concerning the mastoid obliteration with synthetic material, as we focused on looking for outcomes and reported complications. Out of a total of 244 citations, 15 articles were identified, where patients underwent mastoid obliteration with synthetic materials. Most authors used bioactive glass as a filler material. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. On the basis of the available limited literature, it seems that mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. The bioactive glass appears to be the most reliable synthetic material.
Topics: Cholesteatoma, Middle Ear; Chronic Disease; Ear Canal; Humans; Mastoid; Mastoidectomy; Otitis Media; Surgical Flaps; Treatment Outcome
PubMed: 31846919
DOI: 10.5152/iao.2019.7038 -
Folia Morphologica 2021Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of...
BACKGROUND
Localisation of the greater occipital nerve (GON) is essential for the achievement of several procedures performed in the occipital region especially the treatment of occipital neuralgia. This study proposed to investigate the location of GON subcutaneous (Sc) and semispinalis capitis (SSC) piercing points related to the intermastoid and external occipital protuberance (EOP) to mastoid process (MP) lines.
MATERIALS AND METHODS
The Sc piercing point, relation to SSC and obliquus capitis inferior (OCI) muscles of 100 GONs from 50 cadaveric heads (23 males, 27 females) were dissected. Distances from EOP to MP (EM line) on both sides and between MPs (MM line) were measured. Perpendicular lines from Sc and SSC piercing points to EM and MM lines were created and measured. Distances from EOP to the perpendicular lines of SSC piercing point and from MP to the perpendicular lines of Sc piercing point were measured and calculated into percentage of EM and MM length, respectively.
RESULTS
Three types of Sc piercing points (I, II and III) were obtained. The percentage of GON piercing trapezius muscle (TP) (type I), aponeurosis of TP (type II) and aponeurosis between TP and sternocleidomastoid muscle (SCM) (type III) were 2, 67 and 31, respectively. In addition, 95% of GON pierced SSC, 2% pierced its tendinous band and 3% travelled between its medial fibres and the nuchal ligament. 94% of the GON turned around the lower edge of the OCI, while 6% pierced the lower edge of this muscle. Sc piercing point was always located above the MM line, but it could be above, below or on the EM line. In contrast, all of the SSC piercing points were located below the EM line except in one specimen, but it could be above, below or on the MM line. Therefore, the MM and EM lines were used as reference lines for locating the Sc and SSC piercing points, respectively. The mean EM line length was 81.26 ± 5.26 mm with statistically significant differences between genders and sides in female. The mean MM line length was 121.77 ± 8.54 mm with a statistically significant difference between genders. Sc piercing point could be located at 44% of MM line length from ipsilateral MP with a mean vertical distance of 18 mm. No statistically significant difference was found between genders and sides in these parameters, but a statistically significant difference was found in the percentage of MB to MM line between type III and type I (p = 0.02). SSC piercing point of all types could be located at the point of 25% of EM line length from EOP with a vertical distance of 18 mm below EM line. No statistically significant difference was found between genders, sides and types of both piercing points.
CONCLUSIONS
MM and EM lines are potential reference lines for locating the Sc and SSC piercing points of GON, respectively.
Topics: Female; Head; Humans; Male; Mastoid; Neck; Neck Muscles; Occipital Bone
PubMed: 32844388
DOI: 10.5603/FM.a2020.0099 -
Scientific Reports Feb 2021This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell's palsy (BP) and Ramsay Hunt...
This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T-temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bell Palsy; Child; Diagnosis, Differential; Exudates and Transudates; Female; Herpes Zoster Oticus; Humans; Magnetic Resonance Imaging; Male; Mastoid; Middle Aged; Tympanic Membrane
PubMed: 33542465
DOI: 10.1038/s41598-021-82984-w -
Archiwum Medycyny Sadowej I Kryminologii 2015Assessment of the usefulness of intravital lesions in the proximal attachment of the sternocleidomastoid muscle and the mastoid process of the temporal bone in... (Comparative Study)
Comparative Study
Searching for new features of intravitality of hanging based on macro- and microscopic evaluation of the proximal attachment of the sternocleidomastoid muscle and the mastoid process of the temporal bone.
AIM OF THE STUDY
Assessment of the usefulness of intravital lesions in the proximal attachment of the sternocleidomastoid muscle and the mastoid process of the temporal bone in medico-legal evaluation of death by hanging.
MATERIAL AND METHODS
The study material was obtained from the bodies of 35 people who died by hanging. The control group comprised specimens collected from 30 people who died of non-traumatic causes. The structures under study were examined macro- and microscopically. The basic change which could be recognized as a marker of intravitality of hanging was the presence of a macroscopically extensive blotchy area of abundant ecchymosis in the proximal muscle attachment, similar to that found in the distal attachment, and the presence of abundant diffuse intraosseous ecchymoses in the mastoid process.
RESULTS
None of the cases revealed any ecchymoses in the proximal attachment of the muscle that would be similar to those present in the distal attachment. Discolourations within the mastoid processes, macroscopically suggestive of extensive intraosseous effusions arising from the mechanism of stretching, were not confirmed by microscopic evaluation and occurred at the same frequency as in the control group. Limitations of the study were related to the method which involved sample collection by means of bone chisels, decalcification and preparation of specimens, which had an effect, for example, on the measurable evaluation of the degree of congestion.
CONCLUSIONS
The study has failed to provide convincing and unambiguous data on the usefulness of examining mastoid processes and proximal attachments of the sternocleidomastoid muscles during autopsy to determine the presence of intravitality features of hanging. A description of research methodology and its associated difficulties, e.g. with the interpretation of results, can also be useful for the planning of similar studies by other researchers.
Topics: Asphyxia; Facial Injuries; Facial Muscles; Forensic Pathology; Fractures, Bone; Humans; Hyoid Bone; Mastoid; Neck Injuries; Neck Muscles; Suicide
PubMed: 27003864
DOI: 10.5114/amsik.2015.58159 -
European Archives of... May 2022To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery.
STUDY DESIGN
Double-blind, prospective, randomized clinical trial.
SETTING
tertiary referral center.
INTERVENTION(S)
On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated.
MAIN OUTCOME MEASURE(S)
Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam.
RESULTS
The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap.
CONCLUSIONS
This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
Topics: Cholesteatoma, Middle Ear; Cochlear Implantation; Cochlear Implants; Humans; Mastoid; Mastoidectomy; Prospective Studies; Retrospective Studies; Surgical Wound; Treatment Outcome
PubMed: 34110455
DOI: 10.1007/s00405-021-06907-1 -
European Archives of... Aug 2022To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to...
PURPOSE
To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction.
METHODS
This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing.
RESULTS
79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques.
CONCLUSION
We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.
Topics: Adult; Cholesteatoma, Middle Ear; Ear Canal; Humans; Mastoid; Reoperation; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34705081
DOI: 10.1007/s00405-021-07138-0 -
La Radiologia Medica Sep 2023Cholesteatoma is caused by disorders of the middle ear ventilation that trigger a progressive series of events responsible for its formation. The aim of this study was...
BACKGROUND
Cholesteatoma is caused by disorders of the middle ear ventilation that trigger a progressive series of events responsible for its formation. The aim of this study was to identify possible radiological CT-derived parameters predisposing to ventilation disorders and cholesteatoma.
METHODS
In this retrospective study, patients diagnosed with cholesteatomatous chronic otitis media who underwent temporal bone CT and open tympanoplasty surgery have been included, as well as control patients with clinical examination negative for organic otological pathology who underwent temporal bone CT for other reasons. For each patient, the following parameters have been extracted from CT volumes: degree of mastoid pneumatization, prominence of the cog, patency of the Eustachian tube, antrum width, aditus width, anterior and posterior epitympanic widths, and epitympanic height.
RESULTS
Sixty patients have been included, thirty of whom belonged to the group of patients with cholesteatoma and the remaining part to the group of patients without organic otological pathology. The prevalence of a low degree of mastoid pneumatization was significantly higher among patients with cholesteatoma, as well as for the prevalence of cog prominence (p < 0.001). All the continuous variables were found to have statistical significance (p < 0.05) in the comparison between groups except for the width of the antrum.
CONCLUSION
Mastoid pneumatization degree, prominence of the cog and epitympanic measures based on temporal bone CT could be good radiological correlates of the ventilatory capabilities of the epitympanum which, if compromised, can facilitate the development of cholesteatoma.
Topics: Humans; Cholesteatoma, Middle Ear; Retrospective Studies; Temporal Bone; Mastoid; Tomography, X-Ray Computed
PubMed: 37537372
DOI: 10.1007/s11547-023-01677-8 -
Ear, Nose, & Throat Journal Aug 2021Mastoid reconstruction principle had been described to overcome problems of chronic discharging cavity. Different materials were used; nonbiologic materials seem to be...
OBJECTIVES
Mastoid reconstruction principle had been described to overcome problems of chronic discharging cavity. Different materials were used; nonbiologic materials seem to be less preferred. Platelet-rich plasma (PRP) could promote the regeneration of mineralized tissues. In this work, the authors present a simple and easy technique for mastoid reconstruction with PRP and cortical bone pate.
METHODS
The study design is a case series. Patients had mastoid reconstruction after canal wall down mastoidectomy using PRP and cortical bone pate.
RESULTS
This study included 21 patients: 9 males, and 12 females. Sixteen patients had left side disease. All surgical procedures were conducted smoothly within 90 to 135 minutes with no stressful events had been reported. At 12 to 16 months of follow-up, external canal stenosis and mastoid fistulas were not reported. Good healing of the tympanic membrane was seen in 18 patients. No radiological signs suggestive of recurrence were detected and the reconstructed mastoid cavity was smooth and well aerated. Residual tympanic membrane perforations were detected in 3 patients.
CONCLUSION
Autologous materials (PRP and bone pate pate) after canal wall down mastoidectomy appear to be a reliable and effective choice for mastoid reconstruction.
Topics: Adult; Blood Transfusion, Autologous; Bone Transplantation; Cortical Bone; Female; Humans; Male; Mastoid; Mastoidectomy; Middle Aged; Platelet-Rich Plasma; Plastic Surgery Procedures; Surgical Flaps; Transplantation, Autologous; Treatment Outcome; Young Adult
PubMed: 31581830
DOI: 10.1177/0145561319879789 -
Ear, Nose, & Throat Journal Dec 2012A cadaveric study was performed to test the hypothesis that intact-canal-wall mastoidectomy (ICWM) with otoendoscopy allows for equal or better visualization of the...
A cadaveric study was performed to test the hypothesis that intact-canal-wall mastoidectomy (ICWM) with otoendoscopy allows for equal or better visualization of the middle ear cavity structures when compared with canal-wall-down mastoidectomy (CWDM) with microscopy. Ten temporal bones were prepared with a reversible canal-wall-down tympanomastoidectomy technique. Five anatomic sites in each middle ear cavity (lateral epitympanum, posterior crus of the stapes, the sinus tympani, eustachian tube orifice, and round window niche) were marked with paint. Two otolaryngologists blinded to the purpose of the study viewed the temporal bones with the microscope. Following replacement of the posterior canal walls, the bones were then viewed with a 30° and a 70° otoendoscope. All visualized paint marks for each viewing were recorded and compared. We found that ICWM with 30° or 70° otoendoscopy provided significantly better visualization of the sinus tympani than did CWDM (p ≤ 0.001). There was no significant difference among the three methods in visualization of the lateral epitympanum, posterior crus of the stapes, and round window niche. With respect to the eustachian tube orifice, one of the observers reported significantly better visualization with CWDM (p = 0.036). With adjunctive otoendoscopy, it is not necessary to remove the posterior canal wall to adequately visualize or remove disease from various areas of the middle ear cleft. The use of otoendoscopy during cholesteatoma surgery may allow for more frequent preservation of the posterior canal wall and reduced rates of residual cholesteatoma, given the equal or better visualization of the middle ear cavity.
Topics: Ear Canal; Ear, Middle; Endoscopy; Humans; Mastoid; Microscopy; Tympanic Membrane
PubMed: 23288818
DOI: 10.1177/014556131209101208