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Operative Techniques in... Jun 2022In this article, we aim to summarize the impacts of COVID-19 on the practice of otologic surgery. Cadaveric studies have indicated COVID-19 viral particles are present...
In this article, we aim to summarize the impacts of COVID-19 on the practice of otologic surgery. Cadaveric studies have indicated COVID-19 viral particles are present in the middle ear mucosa of infected hosts. Otologic procedures can generate significant amounts of droplets due to reliance on high-speed drills. Multiple guidelines have been developed to improve patient and provider safety peri-operatively. Particle dispersion can be mitigated during microscopic mastoidectomy by utilizing barrier drape techniques. The barrier drape may similarly be applied to the surgical exoscope. Endoscopic techniques have theoretical improved safety benefits by minimizing the need for drilling. The discoveries and innovations borne of the COVID-19 pandemic will lay the groundwork for the practice of otology amidst future pandemics.
PubMed: 35502269
DOI: 10.1016/j.otot.2022.04.004 -
Otolaryngologic Clinics of North America Dec 2020The severe acute respiratory syndrome corona virus 2, responsible for the worldwide COVID-19 pandemic, has caused unprecedented changes to society as we know it. The... (Review)
Review
The severe acute respiratory syndrome corona virus 2, responsible for the worldwide COVID-19 pandemic, has caused unprecedented changes to society as we know it. The effects have been particularly palpable in the practice of medicine. The field of otolaryngology has not been spared. We have had to significantly alter the way we provide care to patients, changes that are likely to become a new norm for the foreseeable future. This article highlights some of the changes as they apply to otology/neurotology. Although this is written from the perspective of an academic physician, it is also applicable to private practice colleagues.
Topics: COVID-19; Coronavirus Infections; Elective Surgical Procedures; Female; Humans; Infection Control; Male; Neurotology; Otologic Surgical Procedures; Pandemics; Pneumonia, Viral; Safety Management; Severe Acute Respiratory Syndrome; United States
PubMed: 33127042
DOI: 10.1016/j.otc.2020.08.003 -
International Archives of... Apr 2023Recently, there have been significant advancements in transcanal endoscopic ear surgery (TEES). The combination of rigid and thin otoendoscopes with high-definition...
Recently, there have been significant advancements in transcanal endoscopic ear surgery (TEES). The combination of rigid and thin otoendoscopes with high-definition cameras enabled a less invasive transcanal access to the middle ear and a clearer view of the surgical field. Several surgeons have recently published studies about cholesteatoma resection via transcanal endoscopic surgery, even in cases where the disease has extended to the mastoid, requiring transcanal endoscopic mastoidectomy. To analyze the currently available literature on transcanal endoscopic inside-out mastoidectomy, and to determine its efficacy as a surgical technique by evaluating the disease's relapse/recurrence rate. Initially, the titles and abstracts of articles identified were analyzed. At this stage, 117 articles were analyzed, 97 of which were excluded for not meeting the inclusion criteria. The 20 remaining articles were further evaluated. The articles were classified on the basis of five levels of scientific evidence. The analysis of the studies showed that the transcanal endoscopic approach is effective in providing access to the attic or antrum, especially in cases of sclerotic mastoids. There was only one study with grade A recommendation, which showed the efficacy of endoscopic ear surgery in the treatment of cholesteatoma. Furthermore, there were three studies with grade B recommendation, showing less relapse/recurrence after TEES. More studies with grade A and B recommendations are needed to better evaluate the effectiveness of TEES, especially compared with that of traditional microscopic surgery.
PubMed: 37125367
DOI: 10.1055/s-0043-1768202 -
Indian Journal of Otolaryngology and... Aug 2022Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality...
Endoscopes are presently used as an adjunct to microscopic surgery for better visualization of hidden areas of middle ear or they are used as a primary modality replacing the microscopes. We performed primary endoscopic ear surgery at a tertiary care center to evaluate the scope of endoscopic ear surgeries and to evaluate the anatomical, functional and quality of life outcomes. We evaluated 103 cases of which included patients with chronic otitis media mucosal disease (64), chronic otitis media squamous disease (29), otosclerosis (6), and benign ear tumors (4). In our study, the structural and functional outcomes of endoscopic ear surgeries were comparable to microscopic techniques however it conferred superior patient related outcomes of cosmesis, post-operative pain and early return to daily routine. Thus endoscopic ear surgery is a minimally invasive alternative option to microscopic techniques in the field of otology.
PubMed: 36032880
DOI: 10.1007/s12070-020-02042-1 -
BMJ Case Reports Dec 2020
Topics: Child; Cholesteatoma, Middle Ear; Ear Auricle; Humans; Mastoidectomy; Mastoiditis; Tomography, X-Ray Computed
PubMed: 33371002
DOI: 10.1136/bcr-2020-239745 -
European Archives of... Jun 2022To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients...
PURPOSE
To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center.
METHODS
We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis.
RESULTS
282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). 'Mastoidectomy' and 'Ossicular reconstruction' parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox.
CONCLUSION
Our results show the utility of SAMEO-ATO framework, and in particular of 'M' (Mastoidectomy) and 'O' (Ossicular reconstruction) parameters, in predicting the hearing outcome.
Topics: Adult; Cholesteatoma, Middle Ear; Humans; Mastoid; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34309753
DOI: 10.1007/s00405-021-07000-3 -
International Archives of... Apr 2016Introduction Posterior tympanotomy approach for cochlear implant (CI) surgery, has been the most commonly used worldwide with current 0.7% rate of facial nerve injury.... (Review)
Review
Introduction Posterior tympanotomy approach for cochlear implant (CI) surgery, has been the most commonly used worldwide with current 0.7% rate of facial nerve injury. Non-mastoidectomy CI approaches include the suprameatal approach (SMA) and its modifications, the transcanal approach and its modifications and the pericanal approach for electrode insertion. Objectives The objective of this study was to review the literature regarding non-mastoidectomy CI approaches. Data Synthesis A search was performed in the LILACS, MEDLINE, SciELO, PubMed databases and Cochrane Library in February 2015, and the key words used in the search were CI, SMA, transcanal approach, pericanal approach, or electrode extrusion. About 30 studies that met the criteria described in "Study Selection" were read in full. The studies showed 1014 patients that underwent CI by SMA or its modifications, 266 CI patients treated by transcanal approach or its modifications, and 15 patients implanted by the pericanal approach. Reported complication with SMA was 99 (9.8%) minor and 13 (1.3%) major. With transcanal, there were 24 complications; 19 (7.1%) minor and 5 (1.9%) major. No post-operative complication was reported in pericanal approach. Studies showed no reported facial nerve paresis or paralysis in all non-mastoidectomy approaches. Conclusion Complications rates with non-mastoidectomy approaches are similar to those found in the mastoidectomy approach. Thus, non-mastoidectomy approaches may be an alternative in cases where the conventional mastoidectomy approach is difficult to perform. It would be helpful for CI surgeons to become familiarized with these approaches.
PubMed: 27096025
DOI: 10.1055/s-0035-1558871 -
Ear, Nose, & Throat Journal Nov 2020To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea. (Review)
Review
OBJECTIVES
To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea.
METHODS
The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords.
RESULTS
Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Nevertheless, chronic otorrhea refractory to an otolaryngologist's traditional treatment algorithm still occurs and may benefit from a mastoidectomy with antibiotic irrigation using a catheter in certain cases. We theorize that resolution of otorrhea results from this technique by decreasing the burden of diseased mucosa and providing a larger concentration or dose of antibiotic to the middle ear cleft through the antrum. High-resolution images of the technique and catheter placement are included in this review.
CONCLUSIONS
Despite being an uncommon management strategy, the literature suggests an indication for performing a mastoidectomy in a small percentage of patients with a chronically draining tympanostomy tube.
Topics: Anti-Bacterial Agents; Catheters; Child; Child, Preschool; Chronic Disease; Drainage; Female; Humans; Male; Mastoidectomy; Mastoiditis; Middle Ear Ventilation; Otitis; Otitis Media with Effusion; Prosthesis-Related Infections; Therapeutic Irrigation
PubMed: 32189520
DOI: 10.1177/0145561320913350 -
BMJ Clinical Evidence Aug 2012Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment and disability. Occasionally it can lead to fatal intracranial infections and acute... (Review)
Review
INTRODUCTION
Chronic suppurative otitis media (CSOM) is a common cause of hearing impairment and disability. Occasionally it can lead to fatal intracranial infections and acute mastoiditis, especially in developing countries.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic suppurative otitis media in adults and in children? What are the effects of treatments for cholesteatoma in adults and in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 51 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: topical ear cleansing, surgery for cholesteatoma, systemic antibiotics, topical antibiotics, topical antibiotics plus topical corticosteroids, topical antiseptics, topical corticosteroids, tympanoplasty (with or without mastoidectomy).
Topics: Anti-Bacterial Agents; Chronic Disease; Humans; Mastoid; Otitis Media, Suppurative; Tympanoplasty
PubMed: 23870746
DOI: No ID Found