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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 -
Journal of Microbiology, Immunology,... Oct 2012Acute mastoiditis has been increasingly reported. We reviewed our experience of mastoiditis in children in the era of expanding application of imaging tools and endless...
BACKGROUND/PURPOSE
Acute mastoiditis has been increasingly reported. We reviewed our experience of mastoiditis in children in the era of expanding application of imaging tools and endless emerging antimicrobial resistance.
METHODS
We reviewed all medical records of children (< 18 years of age) hospitalized with mastoiditis between January 2001and December 2010. Diagnosis of mastoiditis was based on clinical features and confirmed by imaging studies. Patients were classified as having acute or nonacute mastoiditis according to the duration of the disease. Acute mastoiditis was defined as illness of less than 3 weeks prior to hospitalization. Cases of longer than 3 weeks' duration were defined as nonacute mastoiditis. We compared the clinical, laboratory and microbiological features of acute and nonacute mastoiditis.
RESULTS
A total of 104 children were enrolled in this study, comprising 56 acute cases and 48 nonacute cases. Fever and coryza were significantly more common in acute cases. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both initially higher in acute mastoiditis. CRP, rather than ESR, declined faster in acute than in nonacute mastoiditis. Computerized tomography (CT) scans, but not plain films, were highly sensitive. Streptococcus pneumoniae and Haemophilus influenzae accounted for 52% of all isolates. Staphylococci, Pseudomonas spp. and polymicrobials were predominantly seen in non-acute mastoiditis.
CONCLUSION
With the application of imaging studies, many cases of mastoiditis were identified. The classical postauricular signs were present in only 10% of patients. The presenting symptoms, inflammatory markers, pathogens, management and outcome were greatly influenced by the duration of the illness prior to admission.
Topics: Bacterial Infections; Child; Child, Preschool; Clinical Laboratory Techniques; Clinical Medicine; Diagnostic Tests, Routine; Female; Hospitalization; Humans; Infant; Male; Mastoiditis; Radiography; Radiology; Retrospective Studies
PubMed: 22578647
DOI: 10.1016/j.jmii.2011.12.008 -
Anales de Pediatria (Barcelona, Spain :... Jun 2004
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Humans; Infant; Mastoiditis; Retrospective Studies
PubMed: 15207180
DOI: 10.1016/s1695-4033(04)78338-1 -
Danish Medical Journal Aug 2016Virtual reality (VR) simulation-based training is increasingly used in surgical technical skills training including in temporal bone surgery. The potential of VR... (Review)
Review
Virtual reality (VR) simulation-based training is increasingly used in surgical technical skills training including in temporal bone surgery. The potential of VR simulation in enabling high-quality surgical training is great and VR simulation allows high-stakes and complex procedures such as mastoidectomy to be trained repeatedly, independent of patients and surgical tutors, outside traditional learning environments such as the OR or the temporal bone lab, and with fewer of the constraints of traditional training. This thesis aims to increase the evidence-base of VR simulation training of mastoidectomy and, by studying the final-product performances of novices, investigates the transfer of skills to the current gold-standard training modality of cadaveric dissection, the effect of different practice conditions and simulator-integrated tutoring on performance and retention of skills, and the role of directed, self-regulated learning. Technical skills in mastoidectomy were transferable from the VR simulation environment to cadaveric dissection with significant improvement in performance after directed, self-regulated training in the VR temporal bone simulator. Distributed practice led to a better learning outcome and more consolidated skills than massed practice and also resulted in a more consistent performance after three months of non-practice. Simulator-integrated tutoring accelerated the initial learning curve but also caused over-reliance on tutoring, which resulted in a drop in performance when the simulator-integrated tutor-function was discontinued. The learning curves were highly individual but often plateaued early and at an inadequate level, which related to issues concerning both the procedure and the VR simulator, over-reliance on the tutor function and poor self-assessment skills. Future simulator-integrated automated assessment could potentially resolve some of these issues and provide trainees with both feedback during the procedure and immediate assessment following each procedure. Standard setting by establishing a proficiency level that can be used for mastery learning with deliberate practice could also further sophisticate directed, self-regulated learning in VR simulation-based training. VR simulation-based training should be embedded in a systematic and competency-based training curriculum for high-quality surgical skills training, ultimately leading to improved safety and patient care.
Topics: Clinical Competence; Education, Medical, Graduate; Humans; Learning Curve; Mastoid; Otolaryngology; Self-Assessment; Simulation Training
PubMed: 27477803
DOI: No ID Found -
Canadian Family Physician Medecin de... Sep 2017Acute otitis media is one of the most common infections in childhood. Routine prescription of antibiotics has led to adverse events and bacterial resistance to... (Review)
Review
Acute otitis media is one of the most common infections in childhood. Routine prescription of antibiotics has led to adverse events and bacterial resistance to antibiotics. I have heard that "watchful waiting" is a good strategy to reduce this potential problem in children older than 6 months of age. Should I apply this strategy in my clinical practice? Watchful waiting can be applied in selected children with nonsevere acute otitis media by withholding antibiotics and observing the child for clinical improvement. Antibiotics should be promptly provided if the child's infection worsens or fails to improve within 24 to 48 hours. Guidelines and most ongoing studies support these recommendations. Correct choice of regimen, dose, frequency, and length of treatment are all important.
Topics: Anti-Bacterial Agents; Canada; Child; Child, Preschool; Humans; Mastoiditis; Otitis Media; Pain Management; Randomized Controlled Trials as Topic; Severity of Illness Index; Watchful Waiting
PubMed: 28904032
DOI: No ID Found -
European Journal of Pediatrics Jun 2007The "wait and see" approach in acute otitis media (AOM), consisting of postponing the antibiotic administration for a few days, has been advocated mainly to counteract... (Review)
Review
The "wait and see" approach in acute otitis media (AOM), consisting of postponing the antibiotic administration for a few days, has been advocated mainly to counteract the increased bacterial resistance in respiratory infections. This approach is not justified in children less than 2 years of age and this for several reasons. First, AOM is an acute inflammation of the middle ear caused in about 70% of cases by bacteria. Redness and bulging of the tympanic membrane are characteristic findings in bacterial AOM. Second, AOM is associated with long-term dysfunction of the inflamed eustachian tube (ET), particularly in children less than 2 years of age. In this age group, the small calibre of the ET together with its horizontal direction result in impaired clearance, ventilation and protection of the middle ear. Third, recent prospective studies have shown poor long-term prognosis of AOM in children below 2 years with at least 50% of recurrences and persisting otitis media with effusion (OME) in about 35% 6 months after AOM. Viruses elicit AOM in about 30% of children. A prolonged course of AOM has been observed when bacterial and viral infections are combined because viral infection is also associated with ET dysfunction in young children. Bacterial and viral testing of the nasopharyngeal aspirate is an excellent tool both for initial treatment and recurrence of AOM. Antibiotic treatment of AOM is mandatory in children less than 2 years of age to decrease inflammation in the middle ear but also of the ET particularly during the first episode. The best choice is amoxicillin because of its superior penetration in the middle ear. Streptococci pneumoniae with intermediary bacterial resistance to penicillin are particularly associated with recurrent AOM. Therefore the dosage of amoxicillin should be 90 mg/kg per day in three doses. In recurrent AOM with beta-lactamase-producing bacilli, amoxicillin should be associated with clavulanic acid at a dose of 6.4 mg/kg per day. The duration of the treatment is not established yet but 10 days is reasonable for a first episode of AOM. OME may be a precursor initiating AOM but also a complication thereof. OME needs a watchful waiting approach. When associated with deafness for 2-3 months in children over 2 years of age, an antibiotic should be given according to the results of the bacterial resistance in the nasopharyngeal aspirate. The high rate of complications of tympanostomy tube insertion outweighs the beneficial effect on hearing loss. The poor results of this procedure are due to the absence of effects on ET dysfunction. Pneumococcal vaccination has little beneficial effects on recurrent AOM and its use in infants needs further studies. Treatment with amoxicillin is indicated in all children younger than 2 years with a first episode of AOM presenting with redness and bulging of the tympanic membrane. Combined amoxicillin and clavulanic acid should be given in patients with beta-lactamase-producing bacteria. The duration of treatment is estimated to be at least 10 days depending on the findings by pneumo-otoscopy and tympanometry. Bacterial and viral testing of the nasopharyngeal aspirate is highly recommended particularly in children in day care centres as well as for regular follow-up. The high recurrence rate is due to the long-lasting dysfunction of the eustachian tube and the immune immaturity of children less than 2 years of age.
Topics: Acute Disease; Anti-Bacterial Agents; Eustachian Tube; Humans; Infant; Mastoiditis; Middle Ear Ventilation; Otitis Media with Effusion
PubMed: 17364173
DOI: 10.1007/s00431-007-0461-8 -
Brazilian Journal of Otorhinolaryngology 2006
Topics: Audiometry; Hearing Loss; Humans; Male; Mastoid; Middle Aged; Otoscopy; Severity of Illness Index; Tomography, X-Ray Computed
PubMed: 17119785
DOI: 10.1016/s1808-8694(15)30982-4 -
Clinical Otolaryngology : Official... Jan 2022To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK. (Observational Study)
Observational Study
OBJECTIVES
To explore the impact of COVID-19 on the management and outcomes of acute paediatric mastoiditis across the UK.
DESIGN
National retrospective and prospective audit.
SETTING
48 UK secondary care ENT departments.
PARTICIPANTS
Consecutive children aged 18 years or under, referred to ENT with a clinical diagnosis of mastoiditis.
MAIN OUTCOME MEASURES
Cases were divided into Period 1 (01/11/19-15/03/20), before the UK population were instructed to reduce social contact, and Period 2 (16/03/20-30/04/21), following this. Periods 1 and 2 were compared for population variables, management and outcomes. Secondary analyses compared outcomes by primary treatment (medical/needle aspiration/surgical).
RESULTS
286 cases met criteria (median 4 per site, range 0-24). 9.4 cases were recorded per week in period 1 versus 2.0 in period 2, with no winter increase in cases in December 2020-Febraury 2021. Patient age differed between periods 1 and 2 (3.2 vs 4.7 years respectively, p < 0.001). 85% of children in period 2 were tested for COVID-19 with a single positive test. In period, 2 cases associated with P. aeruginosa significantly increased. 48.6% of children were scanned in period 1 vs 41.1% in period 2. Surgical management was used more frequently in period 1 (43.0% vs 24.3%, p = 0.001). Treatment success was high, with failure of initial management in 6.3%, and 30-day re-admission for recurrence in 2.1%. The adverse event rate (15.7% overall) did not vary by treatment modality or between periods 1& 2.
CONCLUSION
The COVID-19 pandemic led to a significant change in the presentation and case mix of acute paediatric mastoiditis in the UK.
Topics: Acute Disease; Adolescent; COVID-19; Child; Child, Preschool; Female; Humans; Incidence; Infant; Male; Mastoiditis; Pandemics; Prospective Studies; Retrospective Studies; SARS-CoV-2; Seasons; United Kingdom
PubMed: 34606691
DOI: 10.1111/coa.13869 -
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 -
Radiologia 2021The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used...
OBJECTIVE
The radiological evaluation of the postsurgical middle ear is complex due to the intricate anatomy of this region and the wide variety of procedures and materials used iin middle ear surgery. Knowledge of these factors will enable normal postsurgical changes to be differentiated from complications. This article describes the most common surgical procedures in the middle ear, their indications, and the normal radiological appearance after these procedures. It reviews the most common causes of failure in stapes surgery, in surgery for chronic otitis media, and in surgery for cholesteatoma, suggesting the best imaging method to assess the middle ear in each case.
CONCLUSION
Computed tomography enables the evaluation of prostheses and the aeration of the cavities, whereas magnetic resonance imaging makes it possible to characterize the possible occupation of the cavities and is the technique of choice for the follow-up of closed mastoidectomy for cholesteatomas.
Topics: Cholesteatoma, Middle Ear; Ear, Middle; Humans; Mastoid; Mastoidectomy; Treatment Outcome
PubMed: 34625199
DOI: 10.1016/j.rxeng.2021.04.006