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Ear, Nose, & Throat Journal Jun 2023To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy.
OBJECTIVES
To evaluate the feasibility, morphological, and functional outcomes of endoscopic retrograde transcanal mastoidectomy.
STUDY DESIGN
Prospective study.
SETTINGS
Tertiary Referral Hospital.
MATERIALS AND METHODS
We analyzed 31 patients with a diagnosis of chronic otitis media with cholesteatoma that extended to the mastoid cavity who underwent endoscopic transcanal retrograde canal wall down mastoidectomy under general anesthesia. The tympanic membrane and posterior canal wall reconstruction were done using the tragal cartilage palisade technique reinforced with perichondrium. Morphological and functional results were reported in the follow-up of a minimum of 1 year. The graft uptake was also compared with the presence of granulations and discharge status.
RESULTS
Graft uptake and disease-free conditions were achieved in 21 of 24 patients, that is, 87.5%, and 3 patients required revision surgery. The graft uptake rate was not affected by the presence of granulation tissues and discharge. The hearing was improved after the surgery, which was statistically significant.
CONCLUSION
Endoscopic retrograde mastoidectomy is a new technique to deal with cholesteatoma with excellent results. It is more functional, ideal for sclerotic mastoid, allows faster wound healing, has excellent outcomes, and is a minimally invasive procedure that avoids postauricular incision and tissue dissection. Because the set up for the surgery costs less, it holds a promising future for the developing countries.
Topics: Humans; Mastoidectomy; Prospective Studies; Cholesteatoma, Middle Ear; Treatment Outcome; Retrospective Studies; Mastoid
PubMed: 33848200
DOI: 10.1177/01455613211009439 -
Journal of Biomedical Optics Jun 2023Cholesteatoma is an expansile destructive lesion of the middle ear and mastoid, which can result in significant complications by eroding adjacent bony structures....
SIGNIFICANCE
Cholesteatoma is an expansile destructive lesion of the middle ear and mastoid, which can result in significant complications by eroding adjacent bony structures. Currently, there is an inability to accurately distinguish cholesteatoma tissue margins from middle ear mucosa tissue, causing a high recidivism rate. Accurately differentiating cholesteatoma and mucosa will enable a more complete removal of the tissue.
AIM
Develop an imaging system to enhance the visibility of cholesteatoma tissue and margins during surgery.
APPROACH
Cholesteatoma and mucosa tissue samples were excised from the inner ear of patients and illuminated with 405, 450, and 520 nm narrowband lights. Measurements were made with a spectroradiometer equipped with a series of different longpass filters. Images were obtained using a red-green-blue (RGB) digital camera equipped with a long pass filter to block reflected light.
RESULTS
Cholesteatoma tissue fluoresced under 405 and 450 nm illumination. Middle ear mucosa tissue did not fluoresce under the same illumination and measurement conditions. All measurements were negligible under 520 nm illumination conditions. All spectroradiometric measurements of cholesteatoma tissue fluorescence can be predicted by a linear combination of emissions from keratin and flavin adenine dinucleotide. We built a prototype of a fluorescence imaging system using a 495 nm longpass filter in combination with an RGB camera. The system was used to capture calibrated digital camera images of cholesteatoma and mucosa tissue samples. The results confirm that cholesteatoma emits light when it is illuminated with 405 and 450 nm, whereas mucosa tissue does not.
CONCLUSIONS
We prototyped an imaging system that is capable of measuring cholesteatoma tissue autofluorescence.
Topics: Humans; Cholesteatoma, Middle Ear; Ear, Middle; Mucous Membrane; Mastoid; Optical Imaging
PubMed: 37334207
DOI: 10.1117/1.JBO.28.6.066003 -
European Radiology Jan 2022To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical...
OBJECTIVES
To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence.
METHODS
Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression.
RESULTS
Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients' age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression.
CONCLUSION
The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors.
KEY POINTS
• Post-operative radiological assessment of the mastoid facial canal and the positional relationship with the CI electrode provide no predictor of post-cochlear implant facial nerve stimulation. • Radiological detection of extracochlear electrode contacts and the previous clinical history of meningitis/encephalitis are two important risk factors for postoperative facial nerve stimulation in cochlear implant patients. • The presence of scala vestibuli electrode insertion as well as the lateral wall electrode type, the younger patient's age, and early onset of SNHL can play important role in the prediction of post-cochlear implant facial nerve stimulation.
Topics: Adult; Aged; Child; Cochlea; Cochlear Implantation; Cochlear Implants; Facial Nerve; Humans; Mastoid; Middle Aged; Retrospective Studies
PubMed: 34226991
DOI: 10.1007/s00330-021-08128-w -
The Journal of International Advanced... Jan 2023Invasive fungal otitis media is clinically rare. The clinical features are often atypical in the early stages of the disease, and delayed treatment results in poor... (Review)
Review
BACKGROUND
Invasive fungal otitis media is clinically rare. The clinical features are often atypical in the early stages of the disease, and delayed treatment results in poor outcomes.
METHODS
In this study, we report 2 patients with invasive fungal otitis media with diabetes. The early diagnosis was confirmed by comprehensive methods such as laboratory tests and imaging examinations, and the condition was significantly improved by antifungal drugs and surgical treatment.
RESULTS
By reviewing the literature, we found that invasive fungal infections confined to the middle ear and mastoid were rarely reported, and the diagnosis and treatment were still controversial.
CONCLUSION
In this article, we summarized and evaluated the different diagnoses and treatment methods so as to better diagnose and improve the cure rate in the early stage of invasive fungal infection of the middle ear.
Topics: Humans; Antifungal Agents; Diabetes Mellitus; Ear, Middle; Mastoid; Otitis Media
PubMed: 36718038
DOI: 10.5152/iao.2023.22743 -
Clinical Neurophysiology : Official... Jul 2023Conventional electroencephalography (EEG) offline subtraction rereferencing is invalid for many clinical practices when adopting a specific nonunipolar recording montage...
OBJECTIVE
Conventional electroencephalography (EEG) offline subtraction rereferencing is invalid for many clinical practices when adopting a specific nonunipolar recording montage (e.g., the ipsilateral mastoid (IM) and contralateral mastoid (CM)). Further comparative analyses would thus be blocked due to the lack of a uniform offline reference. Therefore, our goal was to resolve this problem by introducing and assessing the reference electrode standardization technique (REST) to transform nonunipolar mastoid montages into a computational zero reference at infinity (IR) offline.
METHODS
For EEG signals and power/connectivity configurations, simulation and clinical schizophrenia resting-state EEG datasets were used to investigate the performance of REST.
RESULTS
REST produced small absolute errors (signal level: 1.21-1.26; power: 0.0057-0.021; connectivity: 0.066-0.088) and high correlations (>0.9) between the IM/CM-IR and true IR references. Using clinical data with the IM online reference, REST revealed valuable changes in spectral and connectivity (P < 0.05) in schizophrenia patients, consistent with previous studies.
CONCLUSIONS
These results demonstrated that REST transformation could be adopted to resolve the offline rereferencing of clinical EEGs with specific nonunipolar mastoid references.
SIGNIFICANCE
REST could be an effective and robust resolution for nonunipolar clinical EEGs and could therefore retrieve these data for further analysis by deriving a favorable offline reference IR.
Topics: Humans; Mastoid; Electroencephalography; Head; Computer Simulation; Reference Standards
PubMed: 37116379
DOI: 10.1016/j.clinph.2023.03.361 -
The Journal of International Advanced... May 2021The objective of this multicenter retrospective case review was to assess the natural clinical course, efficacy, and safety of mastoid obliteration with S53P4 Bioactive...
OBJECTIVE
The objective of this multicenter retrospective case review was to assess the natural clinical course, efficacy, and safety of mastoid obliteration with S53P4 Bioactive Glass (bioactive glass).
METHODS
Retrospective case note review in a regional Tertiary Referral Centre and District General Hospital. Patients undergoing mastoid cavity obliteration as part of primary or secondary procedure with bioactive glass between 2012 and 2018. Outcome measures were assessed from a prospectively collated database and case note review. Primary outcomes were the common morbidities of a mastoid cavity; dry or discharging ear (Merchant's scale), vertigo in cold air, and a watertight middle ear. Patients were also assessed for audiological outcomes and recidivism.
RESULTS
Ninety patients were included. During the follow-up period, (mean, 22 months; range, 6-59 months) cholesteatoma recidivism was observed in 2% of ears (2 patients). An acceptably dry (Merchant Grade 0-1) ear was achieved in 91% of all ears (95% primary cases, 80% secondary cases). Delayed healing of the graft in the external ear canal retaining the S53P4BAG Bioactive Glass (BonAlive Ò (BonAlive Ò Biomaterials Ltd., Turku, Finland)) within the mastoid occurred in 13% (12 ears). However, in all cases, conservative management resulted in complete healing.
CONCLUSIONS
Bioactive glass provides a safe and effective means of mastoid obliteration. Complications including overlay graft failure and slow epithelialization, resulting in prolonged postoperative discharge (up to 2 months) and dehiscence into the external ear canal, do not preclude full recovery and may be successfully managed conservatively.
Topics: Cholesteatoma, Middle Ear; Finland; Humans; Mastoid; Otologic Surgical Procedures; Retrospective Studies; Treatment Outcome
PubMed: 34100748
DOI: 10.5152/iao.2021.9053 -
The Journal of International Advanced... Apr 2020Liposarcoma is a soft tissue neoplasm that commonly develops in the lower extremities and rarely in the head and neck region. Herein, we report the case of a patient...
Liposarcoma is a soft tissue neoplasm that commonly develops in the lower extremities and rarely in the head and neck region. Herein, we report the case of a patient with primary liposarcoma that was detected in the mastoid antrum during staged tympanoplasty for cholesteatoma. The tumor adjacent to the attic cholesteatoma was resected completely, and the pathological diagnosis was that of myxoid-type liposarcoma. Because positron emission tomography after the surgery showed no signs of tumor remnants or systemic metastasis, a second-stage surgery was performed 8 months after the first surgery. After confirming that there was no recurrence, tympanoplasty type III with interposition between the stapes and malleus and canal reconstruction was performed. No recurrence was observed for 5 years, and to date, good hearing has been maintained. This is the first report on long-term follow-up of a patient with liposarcoma in the mastoid antrum.
Topics: Aged; Aged, 80 and over; Child, Preschool; Cholesteatoma, Middle Ear; Hearing; Humans; Liposarcoma, Myxoid; Magnetic Resonance Imaging; Male; Mastoid; Mastoidectomy; Middle Aged; Positron-Emission Tomography; Postoperative Care; Treatment Outcome; Tympanoplasty
PubMed: 31257194
DOI: 10.5152/iao.2019.6709 -
The Journal of International Advanced... Jan 2023Langerhans cell histiocytosis is a rare condition affecting the temporal bone in up to 60% of cases. Symptoms are non-specific and the differential diagnosis includes...
Langerhans cell histiocytosis is a rare condition affecting the temporal bone in up to 60% of cases. Symptoms are non-specific and the differential diagnosis includes infection, benign lesions such as cholesteatoma, and malignant lesions of the skull base. Here, we report the case of a 14-yearold child referred with chronic ear discharge, and background of multifocal Langerhans cell histiocytosis 9 years prior. Recurrence of Langerhans cell histiocytosis was initially suspected and systemic treatment was considered. Further imaging workup and surgical exploration of the mastoid showed a secondary acquired cholesteatoma arising from a dehiscent posterior ear canal wall. Surgical removal of the cholesteatoma was performed with a canal wall down procedure. We review the presentation and management of temporal bone Langerhans cell histiocytosis. We recommend that cholesteatoma should be considered in case of recurrence of otological symptoms in patients with a background of Langerhans cell histiocytosis.
Topics: Adolescent; Humans; Cholesteatoma; Cholesteatoma, Middle Ear; Ear Canal; Ear Diseases; Histiocytosis, Langerhans-Cell; Mastoid; Recurrence; Retrospective Studies; Temporal Bone
PubMed: 36718041
DOI: 10.5152/iao.2023.22716 -
Otology & Neurotology : Official... Oct 2021To describe national trends in cholesteatoma management.
OBJECTIVE
To describe national trends in cholesteatoma management.
STUDY DESIGN AND SETTING
Retrospective analysis Optum Clinformatics® Database from 2003 to 2019.
PATIENTS
16,179 unique adult and pediatric patients who received cholesteatoma surgery.
INTERVENTIONS AND MAIN OUTCOME MEASURES
Patients were categorized into three groups by initial surgical modality: canal wall down (CWD), canal wall up (CWU), and tympanoplasty without mastoidectomy (TnoM). Three major comparisons between groups were performed: 1) temporal trends, 2) clinical and sociodemographic determinants, and 3) healthcare use in terms of total costs and incidence of postoperative imaging and subsequent surgery.
RESULTS
Overall, 23.2% received initial CWD surgery, 44.3% CWU, and 32.5% TnoM. 1) The incidence of initial CWD surgery decreased (odds ratios [OR] = 0.98, 95% confidence intervals [CI] [0.97,0.99]), while CWU increased (OR = 1.02, 95% CI [1.01,1.03]), and TnoM remained stable over the study period (OR = 0.99, 95% CI [0.98,1.00]). 2) Relative to CWU, TnoM surgery was less likely in adults, patients with prior complications, and non-White patients, while being more likely in patients with higher household income. CWD was more likely than CWU in adults, patients with prior complications, and non-White patients, while income had no effect. 3) Postoperative costs for CWU and CWD were similar. In 2 years following initial surgery, postoperative imaging and/or subsequent surgery was performed in 45.48% of CWD, 57.42% of CWU, and 41.62% of TnoM patients.
CONCLUSIONS
Incidence of initial CWD surgery decreased and social disparities in cholesteatoma management were observed. Postoperative imaging or second-look surgery were performed in less than 60% of patients with initial CWU surgery and over 40% of patients with initial CWD.
Topics: Adult; Child; Cholesteatoma, Middle Ear; Delivery of Health Care; Humans; Mastoid; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34310551
DOI: 10.1097/MAO.0000000000003284 -
The Journal of International Advanced... Aug 2020To endoscopically evaluate the patency of the isthmus tympanicum and integrity of the tensor tympani fold as routes of ventilation of the attic and mastoid in chronic...
OBJECTIVES
To endoscopically evaluate the patency of the isthmus tympanicum and integrity of the tensor tympani fold as routes of ventilation of the attic and mastoid in chronic otitis media (COM) and to assess their effects on mastoid pneumatization.
MATERIALS AND METHODS
Sixty patients with COM were categorized into two groups: (1) Group A: 36 patients with tympanic membrane perforation (2) Group B: 24 patients with limited attic disease of whom 14 patients had attic retraction pockets and 10 with limited attic cholesteatoma. A multislice computed tomography scan of the temporal bone was performed for each patient to assess the degree of mastoid pneumatization. Notably, either myringoplasty or tympanomastoid surgery was performed in all patients. An endoscope was inserted into the middle ear for evaluation of the isthmus tympanicum and tensor fold area.
RESULTS
The isthmus tympanicum was patent in most ears (83.3%) of group A, whereas it was blocked in most ears (83.3%) of group B. The tensor fold was complete in 77.8% of ears in group A and 83.3% of ears in group B. It was observed that 94.1% of ears with patent isthmus in both groups had normal mastoid pneumatization and 5.9% of ears had poorly pneumatized mastoid. By contrast, 7.7% of ears with blocked isthmus tympanicum had normal mastoid pneumatization and 92.3% had poor mastoid pneumatization. Normal mastoid pneumatization was observed in 50% of ears in both groups with complete tensor fold, and 83.3% of ears with an incomplete tensor fold.
CONCLUSION
A significant correlation was observed between COM with limited attic disease and obstruction of the isthmus tympanicum. Obstruction of isthmus tympanicum was associated with poor mastoid pneumatization. Furthermore, an incomplete tensor fold was associated with well pneumatized mastoid.
Topics: Adult; Air; Case-Control Studies; Cholesteatoma, Middle Ear; Chronic Disease; Ear Canal; Endoscopy; Eustachian Tube; Female; Humans; Male; Mastoid; Multidetector Computed Tomography; Otitis Media; Prospective Studies; Temporal Bone; Tensor Tympani; Tympanic Membrane; Tympanic Membrane Perforation
PubMed: 32209517
DOI: 10.5152/iao.2020.7507