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1.
BMJ Open ; 14(5): e087062, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38806427

RESUMO

INTRODUCTION: Radical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the clarity of the operative field. Our trial is designed to investigate whether the intravenous administration of tranexamic acid (TXA) can improve the clarity of the operative field, reduce the operative time, and increase surgeon satisfaction. METHODS AND ANALYSIS: This study is a prospective, randomised, double-blinded, controlled trial that aims to investigate the effects of TXA on patients with otitis media. The trial will include patients between the ages of 18 and 65 who will be randomly assigned to either the TXA group or the control group. In the TXA group, patients will receive 1 g of TXA diluted to 20 mL of normal saline before anaesthesia induction while the control group will receive 20 mL of normal saline. The primary outcome measure will be the Modena Bleeding Score, which will assess the clarity of the surgical field. Secondary outcomes will include the surgeon's satisfaction with surgical conditions, operation time, laboratory measurements (prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer) and levels of inflammatory factors (such as IL-6) at 24 hours postoperatively. In addition, the incidence of general adverse reactions such as postoperative nausea, vomiting and dizziness; serious adverse events such as arterial and venous thromboembolism, myocardial infarction and epilepsy within 90 days will be compared between the two groups. ETHICS AND DISSEMINATION: The protocol was approved by the Ethics Committee of Peking University People's Hospital (2021PHB173-001), on 19 July 2021. The trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ChiCTR2100049183.


Assuntos
Administração Intravenosa , Antifibrinolíticos , Mastoidectomia , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/administração & dosagem , Ácido Tranexâmico/uso terapêutico , Ácido Tranexâmico/efeitos adversos , Método Duplo-Cego , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/uso terapêutico , Estudos Prospectivos , Adulto , Mastoidectomia/métodos , Pessoa de Meia-Idade , Feminino , Masculino , Adolescente , Otite Média Supurativa/cirurgia , Otite Média Supurativa/tratamento farmacológico , Adulto Jovem , Ensaios Clínicos Controlados Aleatórios como Assunto , Duração da Cirurgia , Idoso
2.
Ann Otol Rhinol Laryngol ; 133(7): 665-671, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38676449

RESUMO

OBJECTIVE: To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. METHODS: A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. RESULTS: Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. CONCLUSION: Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. LEVEL OF EVIDENCE: V.


Assuntos
Colesteatoma da Orelha Média , Análise Custo-Benefício , Imagem de Difusão por Ressonância Magnética , Anos de Vida Ajustados por Qualidade de Vida , Cirurgia de Second-Look , Humanos , Cirurgia de Second-Look/economia , Imagem de Difusão por Ressonância Magnética/economia , Imagem de Difusão por Ressonância Magnética/métodos , Colesteatoma da Orelha Média/cirurgia , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/economia , Mastoidectomia/economia , Mastoidectomia/métodos , Técnicas de Apoio para a Decisão , Estados Unidos
3.
Am J Otolaryngol ; 45(4): 104299, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38657531

RESUMO

INTRODUCTION: Acute mastoiditis (AM) can rapidly become life-threatening with various intracranial complications. The standard care includes antibiotics, mastoidectomy, and drainage. Reports show varying preferences for conservative and surgical treatments, with a more conservative approach gaining popularity. In this study we aim to evaluate the presenting symptoms, management and outcomes of patients presenting with intracranial complications secondary to acute mastoiditis. METHODS: Retrospective review for all children admitted for acute mastoiditis for 12 years period (January 2010-December 2021). Children who had mastoiditis associated with intracranial complications were included in the study. STROBE guidelines were followed in this study. RESULTS: 23 patients were diagnosed with acute mastoiditis with intracranial complications. The mean age was 2.1 years. The most common presenting sign was fever, followed by otalgia. The most common pathogens were Fusobacterium necrophorum and Streptococcus pneumoniae. The most common intracranial complication was sinus vein thrombosis (SVT) affecting 13 patients. Eventually, 10 patients underwent cortical mastoidectomy during 1-6 days upon admission, with an average of 3.2 days. During the follow-up period patients were monitored for clinical progression. Patients who did not show clinical improvement such as persistent fever, worsening symptoms, or the presence of neurological symptoms were treated surgically. The length of stay was an average of 15.5 days overall, with no significantly longer hospital stay in patients who were treated surgically compared to patients who were treated conservatively (17.1 days vs. 14.2 days, P = .26). CONCLUSION: Intracranial complications of acute mastoiditis remain a significant challenge. Selected patients with intracranial complications can be treated conservatively with close monitoring, without increasing the risk of immediate or long-term complications. Initial antimicrobial treatment should cover anaerobic bacteria, as it correlates with severe complications.


Assuntos
Mastoidite , Humanos , Mastoidite/terapia , Mastoidite/microbiologia , Mastoidite/complicações , Mastoidite/etiologia , Masculino , Feminino , Pré-Escolar , Doença Aguda , Estudos Retrospectivos , Criança , Lactente , Mastoidectomia/métodos , Antibacterianos/uso terapêutico , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/terapia , Dor de Orelha/etiologia , Febre/etiologia , Tempo de Internação , Resultado do Tratamento
4.
Otol Neurotol ; 45(4): 410-414, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38437812

RESUMO

OBJECTIVES: The operating microscope (OM) commonly used in ear surgeries has several disadvantages, including a low depth of field, a narrow field of view, and unfavorable ergonomic characteristics. The exoscope (EX) was developed to overcome these disadvantages. Herein, we compared OM and EX during mastoidectomy and found out the feasibility of the EX. STUDY DESIGN: Prospective randomized comparative study. SETTING: Tertiary academic medical center. PATIENTS: Patients who had mastoidectomy for chronic otitis media with or without cholesteatoma between January 2022 and April 2022. INTERVENTION: Canal wall-up mastoidectomy (CWUM) or canal wall-down mastoidectomy (CWDM) using OM or EX without endoscope. MAIN OUTCOME MEASURES: Operative setting time (the time between the end of general anesthesia and incision), operative time (from incision to suture), postoperative audiologic outcomes, perioperative complications, and the decision to switch from EX to OM. RESULTS: Of 24 patients who were diagnosed with chronic otitis media or cholesteatoma, 12 each were randomly assigned to the OM or EX group. The mean operation time was 175 ± 26.5 minutes and 172 ± 34.6 minutes in the EX and OM group, respectively, which was not significantly different ( p = 0.843). The procedures in the EX group were successfully completed using a three-dimensional (3D)-EX without conversion to OM. All surgeries were completed without any complications. The postoperative difference in the air and bone conduction was 11.2 and 12.4 dB in the EX and OM groups, respectively, which was not significantly different ( p = 0.551). CONCLUSIONS: EX is comparable to OM in terms of surgical time, complications, and audiologic outcomes following mastoidectomy. The EX system is a potential alternative to OM. However, further improvements are required to overcome some drawbacks (deterioration of image resolution at high magnification, requirement of an additional controller for refocusing).


Assuntos
Colesteatoma da Orelha Média , Otite Média , Humanos , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Otite Média/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
5.
Otol Neurotol ; 45(5): 542-548, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38511274

RESUMO

OBJECTIVE: To compare recidivism rates, audiometric outcomes, and postoperative complication rates between soft-wall canal wall reconstruction (S-CWR) versus bony-wall CWR (B-CWR) with mastoid obliteration (MO) in patients with cholesteatoma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary neurotologic referral center. PATIENTS: Ninety patients aged ≥18 years old who underwent CWR with MO, either S-CWR or B-CWR, for cholesteatoma with one surgeon from January 2011 to January 2022. Patients were followed postoperatively for at least 12 months with or without second-look ossiculoplasty. INTERVENTIONS: Tympanomastoidectomy with CWR (soft vs. bony material) and mastoid obliteration. MAIN OUTCOME MEASURES: Recidivism rates; conversion rate to CWD; pre- versus postoperative pure tone averages, speech reception thresholds, word recognition scores, and air-bone gaps; postoperative complication rates. RESULTS: Middle ear and mastoid cholesteatoma recidivism rates were not significantly different between B-CWR (17.3%) and S-CWR (18.4%, p = 0.71). There was no significant difference in pre- versus postoperative change in ABG (B-CWR, -2.1 dB; S-CWR, +1.6 dB; p = 0.91) nor in the proportion of postoperative ABGs <20 dB (B-CWR, 41.3%; S-CWR, 30.7%; p = 0.42) between B-CWR and S-CWR. Further, there were no significant differences in complication rates between B-CWR and S-CWR other than increased minor TM perforations/retractions in B-CWR (63% vs. 40%, p = 0.03). CONCLUSIONS: Analysis of recidivism rates, audiometric outcomes and postoperative complications between B-CWR with MO versus S-CWR with MO revealed no significant difference. Both approaches are as effective in eradicating cholesteatoma while preserving relatively normal EAC anatomy and hearing. Surgeon preference and technical skill level may guide the surgeon's choice in approach.


Assuntos
Colesteatoma da Orelha Média , Processo Mastoide , Mastoidectomia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Colesteatoma da Orelha Média/cirurgia , Adulto , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Resultado do Tratamento , Timpanoplastia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/métodos , Idoso , Meato Acústico Externo/cirurgia , Adulto Jovem , Audiometria de Tons Puros , Recidiva
6.
Otolaryngol Head Neck Surg ; 170(6): 1555-1560, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38520201

RESUMO

OBJECTIVE: To develop a convolutional neural network-based computer vision model to recognize and track 2 mastoidectomy surgical instruments-the drill and the suction-irrigator-from intraoperative video recordings of mastoidectomies. STUDY DESIGN: Technological development and model validation. SETTING: Academic center. METHODS: Ten 1-minute videos of mastoidectomies done for cochlear implantation by varying levels of resident surgeons were collected. For each video, containing 900 frames, an open-access computer vision annotation tool was used to annotate the drill and suction-irrigator class images with bounding boxes. A mastoidectomy instrument tracking module, which extracts the center coordinates of bounding boxes, was developed using a feature pyramid network and layered with DETECTRON, an open-access faster-region-based convolutional neural network. Eight videos were used to train the model, and 2 videos were used for testing. Outcome measures included Intersection over Union (IoU) ratio, accuracy, and average precision. RESULTS: For an IoU of 0.5, the mean average precision for the drill was 99% and 86% for the suction-irrigator. The model proved capable of generating maps of drill and suction-irrigator stroke direction and distance for the entirety of each video. CONCLUSIONS: This computer vision model can identify and track the drill and suction-irrigator from videos of intraoperative mastoidectomies performed by residents with excellent precision. It can now be employed to retrospectively study objective mastoidectomy measures of expert and resident surgeons, such as drill and suction-irrigator stroke concentration, economy of motion, speed, and coordination, setting the stage for characterization of objective expectations for safe and efficient mastoidectomies.


Assuntos
Aprendizado Profundo , Mastoidectomia , Redes Neurais de Computação , Gravação em Vídeo , Humanos , Mastoidectomia/métodos , Implante Coclear/métodos , Processo Mastoide/cirurgia , Cirurgia Assistida por Computador/métodos
7.
Eur Arch Otorhinolaryngol ; 281(6): 3283-3287, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38530458

RESUMO

BACKGROUND: While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative. METHODS: Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC. CONCLUSIONS: The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy.


Assuntos
Meato Acústico Externo , Processo Mastoide , Mastoidectomia , Retalhos Cirúrgicos , Humanos , Mastoidectomia/métodos , Meato Acústico Externo/cirurgia , Processo Mastoide/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade
8.
Am J Otolaryngol ; 45(4): 104263, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38547748

RESUMO

OBJECTIVES: To describe a rare complication of cholesteatoma. METHODS: Case report with literature review. RESULTS: We report a case of a 37-year-old male who presented for evaluation of otorrhea, headache, and progressive left sensorineural hearing loss. Clinical and radiologic evaluation demonstrated a large recurrent attic cholesteatoma with erosion into the lateral and superior semicircular canals, and diffuse enhancement of the internal auditory canal and cerebellopontine angle suggestive of hypertrophic pachymeningitis secondary to cholesteatoma. After treatment with a course of antibiotics and canal wall down mastoidectomy surgery for cholesteatoma exteriorization, he experienced improvement of his symptoms and resolution of hypertrophic pachymeningitis. CONCLUSION: Hypertrophic pachymeningitis is a rarely described complication of cholesteatoma. In the context of cholesteatoma, treatment with antibiotics and surgical removal or exteriorization of cholesteatoma are effective treatments for HP.


Assuntos
Ângulo Cerebelopontino , Colesteatoma da Orelha Média , Hipertrofia , Meningite , Humanos , Masculino , Adulto , Meningite/etiologia , Meningite/complicações , Ângulo Cerebelopontino/cirurgia , Ângulo Cerebelopontino/diagnóstico por imagem , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/cirurgia , Recidiva , Orelha Interna/diagnóstico por imagem , Orelha Interna/cirurgia , Imageamento por Ressonância Magnética , Mastoidectomia/métodos , Tomografia Computadorizada por Raios X
10.
Otol Neurotol ; 44(7): e497-e503, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37442608

RESUMO

OBJECTIVE: 3-D printing offers convenient and low-cost mastoidectomy training; nonetheless, training benefits using 3-D-printed temporal bones remain largely unexplored. In this study, we have collected validity evidence for a low-cost, 3-D-printed temporal bone for mastoidectomy training and established a credible pass/fail score for performance on the model. STUDY DESIGN: A prospective educational study gathering validity evidence using Messick's validity framework. SETTING: Seven Danish otorhinolaryngology training institutions. PARTICIPANTS: Eighteen otorhinolaryngology residents (novices) and 11 experienced otosurgeons (experts). INTERVENTION: Residents and experienced otosurgeons each performed two to three anatomical mastoidectomies on a low-cost, 3-D-printed temporal bone model produced in-house. After drilling, mastoidectomy performances were rated by three blinded experts using a 25-item modified Welling scale (WS). MAIN OUTCOME MEASURE: Validity evidence using Messick's framework including reliability assessment applying both classical test theory and Generalizability theory. RESULTS: Novices achieved a mean score of 13.9 points; experienced otosurgeons achieved 23.2 points. Using the contrasting groups method, we established a 21/25-point pass/fail level. The Generalizability coefficient was 0.91, and 75% of the score variance was attributable to participant performance, indicating a high level of assessment reliability. Subsequent D studies revealed that two raters rating one performance or one rater rating two performances were sufficiently reliable for high-stakes assessment. CONCLUSION: Validity evidence supports using a low-cost, 3-D-printed model for mastoidectomy training. The model can be printed in-house using consumer-grade 3-D printers and serves as an additional training tool in the temporal bone curriculum. For competency-based training, we established a cut-off score of 21 of 25 WS points using the contrasting groups method.


Assuntos
Otolaringologia , Treinamento por Simulação , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Osso Temporal/cirurgia , Mastoidectomia/métodos , Otolaringologia/educação , Treinamento por Simulação/métodos , Competência Clínica
11.
Eur Arch Otorhinolaryngol ; 280(8): 3897-3900, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37195344

RESUMO

PURPOSE: It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case. CASE PRESENTATION: A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy. CONCLUSIONS: Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.


Assuntos
Colesteatoma da Orelha Média , Otopatias , Feminino , Humanos , Adulto , Mastoidectomia/métodos , Estudos Retrospectivos , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Orelha Média , Otopatias/cirurgia , Meato Acústico Externo/diagnóstico por imagem , Meato Acústico Externo/cirurgia , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia
12.
Otolaryngol Head Neck Surg ; 169(2): 382-389, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36939424

RESUMO

OBJECTIVE: The optimal management of acute mastoiditis remains controversial. Most existing studies are retrospective single-institutional experiences with small cohorts. Our objectives were to analyze the treatment of acute mastoiditis by pediatric centers across the United States and changes in management over time. STUDY DESIGN: Retrospective analysis. SETTING: Administrative database study using Pediatric Health Information System. METHODS: Patients ≤18 years of age who were admitted with a principal diagnosis of acute mastoiditis from January 1, 2010 to December 31, 2019 were included. Trends were assessed by Cochran-Armitage Trend Test. χ2 and Wilcoxon rank sum tests were used to compare outcomes between the surgical and nonsurgical groups. RESULTS: A total of 2170 patients met the inclusion criteria, with 1248 (57.5%) requiring surgical management. The rate of surgical procedures decreased significantly over time. The rate of myringotomy decreased from 64% in 2010 to 47% in 2019 (p < .001), and mastoidectomy decreased from 22% in 2010 to 10% in 2019 (p < .001). On admission, 29% of the cohort presented with mastoiditis-related complications. Patients treated surgically were younger (p < .001), more likely to present with complications (37.5% vs 17.5%, p < .001), required longer length of stay (3.7 vs 2.3 days, p < .001), and had higher intensive care unit utilization (8.6% vs 2.2%, p < .001). However, the rate of 30-day readmission, emergency department return, and in-hospital mortality were all similar. CONCLUSION: Acute mastoiditis has been successfully treated with declining rates of a surgery over time. Younger patients who present with complications are more likely to be managed surgically, and the overall outcomes remain excellent.


Assuntos
Sistemas de Informação em Saúde , Mastoidite , Criança , Humanos , Lactente , Mastoidite/epidemiologia , Mastoidite/cirurgia , Estudos Retrospectivos , Hospitalização , Mastoidectomia/métodos , Doença Aguda , Antibacterianos/uso terapêutico
13.
Eur Arch Otorhinolaryngol ; 280(8): 3577-3583, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36917252

RESUMO

PURPOSE: To investigate safety and efficacy of mastoid obliteration in canal-wall-down tympanoplasty performed for cholesteatoma using bioactive glass (BAG). The authors routinely adopt CWD tympanoplasty in case of massive cholesteatoma or revision surgery, performing obliteration with BAG to reduce the mastoid cavity and related disadvantages. We assessed anatomical results, infection control and cholesteatoma recurrence in obliterative mastoidectomy using BAG. METHODS: The authors evaluated 66 patients treated with obliterative mastoidectomy using BAG during the period 2010-2021. 48.5% of the cases had first diagnosis of cholesteatoma, 48.5% had cholesteatoma recidivisms, and two patients underwent obliteration to improve clinical outcome. BAG granules were always moistened with venous blood to enhance their adhesion and reduce the risk of dispersion. Anatomical results were evaluated in otomicroscopy and infection control was assessed during follow-up visits. Periodical otomicroscopy was performed to check recurrent cholesteatoma. MRI-DWI was indicated only in case of clinical suspect of cholesteatoma. RESULTS: Authors followed 66 patients during a mean of 23 months. No post-operative wound infections occured. The mean re-epithelialization time was 45 days. At the last visit, control of infection was achieved in 97% of patients and a clinical stable anatomical cavity in all patients. No clinical suspect for recurrent cholesteatoma was found. CONCLUSIONS: The use of bioactive glass is safe and effective as obliteration material in cholesteatoma surgery. Authors pay a particular attention to obliterate only patients without suspect of epithelial residual, to correctly calibrate the ear canal and to completely cover the granules with graft.


Assuntos
Colesteatoma da Orelha Média , Mastoidectomia , Humanos , Mastoidectomia/métodos , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Processo Mastoide/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Timpanoplastia/métodos
14.
Medicine (Baltimore) ; 102(5): e32787, 2023 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-36749232

RESUMO

This study retrospectively investigated the reasons for failure to dry the ear after primary radical mastoidectomy for chronic otitis media. In this retrospective study, we analyzed the main causes of dry ear failure in 43 patients (46 ears) who underwent radical mastoidectomy. We found that inadequate exposure of the mastoid cavity, incomplete removal of pathological tissues, and poor drainage of the surgical cavity were the main reasons for failure of radical mastoidectomy. Lesions in the tympanic ostium of the eustachian tube and incorrect selection of surgical techniques could also cause dry ear failure. Revision surgery based on preoperative temporal bone computed tomography and intraoperative surgical findings could achieve dry ear in 100% of cases and no complications were observed. In patients who underwent tympanoplasty, there was a significant postoperative decrease in the decibel hearing level for the air conduction threshold and air-bone gap ( P  < .05). Based on the reasons for failure, the corresponding treatment was undertaken to achieve dry ears during revision surgery.


Assuntos
Colesteatoma da Orelha Média , Mastoidectomia , Humanos , Mastoidectomia/métodos , Estudos Retrospectivos , Reoperação , Processo Mastoide/cirurgia , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/cirurgia , Resultado do Tratamento , Doença Crônica
15.
Ear Nose Throat J ; 102(6): NP269-NP276, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33848200

RESUMO

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.


Assuntos
Colesteatoma da Orelha Média , Mastoidectomia , Humanos , Mastoidectomia/métodos , Estudos Prospectivos , Colesteatoma da Orelha Média/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Processo Mastoide/cirurgia
16.
J Laryngol Otol ; 137(5): 496-500, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35611600

RESUMO

OBJECTIVE: Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It was hypothesised that endoscopic hydro-mastoidectomy might take less time than endoscopic non-underwater mastoidectomy because the endoscope does not need to be removed for cleaning. METHODS: This study compared the mastoidectomy and total operative durations between the endoscopic hydro-mastoidectomy (n = 25) and endoscopic non-underwater drilling (control, n = 8) groups. Moreover, it compared the size of resected areas of the external auditory canal between the two groups. RESULTS: The mastoidectomy time of the endoscopic hydro-mastoidectomy group was significantly shorter than that of the control group (p < 0.01). The total operative time did not differ significantly between the endoscopic hydro-mastoidectomy and control groups (p = 0.17). The resected area was significantly larger in the endoscopic hydro-mastoidectomy group than in the control group (p < 0.05). CONCLUSION: Endoscopic hydro-mastoidectomy enables more extensive bone resection within a shorter period.


Assuntos
Colesteatoma da Orelha Média , Procedimentos Cirúrgicos Otológicos , Humanos , Mastoidectomia/métodos , Colesteatoma da Orelha Média/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Otológicos/métodos , Endoscopia/métodos , Processo Mastoide/cirurgia , Estudos Retrospectivos
17.
Eur Arch Otorhinolaryngol ; 280(4): 1713-1722, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36208330

RESUMO

PURPOSE: To present the first pediatric study on the safety and efficacy of mastoid obliteration using S53P4 bioactive glass (BAG) for cholesteatoma surgery. METHODS: A single-center retrospective cohort study was conducted. Inclusion criteria were pediatric cases (≤ 18 years) and at least at least one year of follow-up including non-echo planar diffusion-weighted MRI to assess cholesteatoma recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were evaluated. RESULTS: A total of 61 cases (56 patients) were included. Most cases had an otologic history before the development of the cholesteatoma. CWU procedure was performed in 18 cases (30%) and CWD procedure in 43 cases (70%). The cholesteatoma recidivism rate was 33% after a mean follow-up period of 58 months. Kaplan-Meier curve estimated a 5-year recidivism rate of 40%. Few complications were seen that were all minor and resolved spontaneously or after local or systemic treatment. Control of the infection (merchant grade 0-1) was achieved in 98% of the cases. Closure of the air-bone gap within 20 dB was achieved in 22% of the cases with complete audiometric evaluation. CONCLUSION: In this MRI-controlled study, we show the safety and efficacy of S53P4 BAG for mastoid obliteration in a pediatric cholesteatoma cohort. Postoperative complications were both rare and minor, and a dry ear was achieved in almost all patients. Nevertheless, persistent hearing loss and the apparent high recidivism rate reflect the challenging nature of pediatric cholesteatoma.


Assuntos
Colesteatoma da Orelha Média , Processo Mastoide , Humanos , Criança , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/cirurgia , Estudos Retrospectivos , Mastoidectomia/métodos , Timpanoplastia/métodos
18.
Eur Arch Otorhinolaryngol ; 280(4): 1703-1711, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36173443

RESUMO

PURPOSE: To compare the efficacy and safety of hydroxyapatite vs. bone pâté as obliteration material in mastoidectomy surgery for patients with chronic suppurative otitis media and cholesteatoma. METHODS: This is a retrospective, multi-center, cohort study. All patients were followed up with micro-otoscopy, audiometry, and, if indicated, MRI with diffusion-weighted imaging. The following outcome parameters were analyzed: procedure safety (wound infections and complications), cholesteatoma recidivism rates (residual/recurrent), control of infection (Merchant's scale), and hearing results (pure-tone averages at 500/1000/2000/4000 Hz). RESULTS: Eighty-three cases were included: 45 obliterated with hydroxyapatite and 38 with bone pâté, with a mean follow-up time of, respectively, 25 and 24 months. Wound infections were only detected in the bone pâté group (4.8%) and successfully treated with oral or intravenous antibiotics and surgical drainage (p = 0.026). No other major surgical complications were observed in both groups. Cholesteatoma recidivism was observed in 15% using hydroxyapatite and 12% using bone pâté (p = 0.471). Complete control of infection (Merchant 0) was achieved in 76.2% using bone pâté and 86.8% using hydroxyapatite at 12 months postoperatively (p = 0.223). All patients showed good postoperative healing without complete failure to manage infection (Merchant 3). Pre- and postoperative audiometry showed significant improvement in hearing results in both groups. No significant difference between the obliteration materials was observed. CONCLUSIONS: Evaluation of mastoid obliteration reveals that hydroxyapatite and bone pâté are safe and effective obliteration materials, with high success rates in achieving a dry ear, low recidivism rates, and good hearing outcome, respecting the short-term limitation. In addition, our study shows that hydroxyapatite results in fewer postoperative wound infections compared to bone pâté.


Assuntos
Colesteatoma da Orelha Média , Otite Média Supurativa , Humanos , Mastoidectomia/métodos , Otite Média Supurativa/complicações , Otite Média Supurativa/cirurgia , Processo Mastoide/cirurgia , Estudos Retrospectivos , Estudos de Coortes , Durapatita , Colesteatoma da Orelha Média/complicações , Colesteatoma da Orelha Média/cirurgia , Resultado do Tratamento
19.
Acta Bioeng Biomech ; 25(2): 133-145, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38314520

RESUMO

PURPOSE: The aim of this work was to study the effect of canal wall-up (CWU) and canal wall-down (CWD) and mastoid obliteration in conjunction with CWD (CWD-MO) mastoidectomy on the sound transmission characteristics of the human ear. METHODS: Three mastoidectomy surgical methods, CWU, CWD and CWD-MO, were simulated on the freshly dissected cadaver heads. Then, the finite element (FE) models corresponding to these surgical methods were established by micro-computed tomography (Micro-CT) and reverse engineering technology, and the accuracy of the models was verified. Finally, the FE Models were used to analyze the effects of different surgical methods on the sound transmission characteristics of the human ear. RESULTS: For CWU, since the integrity of the outer wall of the ear canal is ensured, the sound pressure (SP) gain of the ear canal and the stapes footplate displacement (FPD) gain after this operation are close to normal values. For CWD, due to severe damage to the outer wall of the ear canal, a negative gain of the ear canal SP occurs in the high-frequency range, and the resonance frequency is significantly reduced. For CWD-MO, the frequency range of SP negative gain in the ear canal is reduced due to the addition of fillers in the ear canal to reduce the degree of damage, and the resonance frequency is increased compared to CWD. CONCLUSIONS: The impact of three types of mastoidectomy, including CWU, CWD, and CWDMO, on the sound transmission characteristics of the human ear after surgery is relatively small.


Assuntos
Colesteatoma da Orelha Média , Mastoidectomia , Humanos , Mastoidectomia/métodos , Processo Mastoide/cirurgia , Microtomografia por Raio-X , Colesteatoma da Orelha Média/cirurgia , Som , Estudos Retrospectivos , Resultado do Tratamento
20.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(4): 443-450, dic. 2022. ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-1431933

RESUMO

Introducción: Existe gran controversia acerca de los signos radiológicos de la patología de oído medio y su relación con la extensión real de la patología que nos sugiera decidir un comportamiento determinado. Objetivo: establecer la concordancia entre los hallazgos radiológicos y quirúrgicos encontrados en pacientes sometidos a mastoidectomía. Material y Método: Diseño observacional descriptivo de corte transversal de prueba diagnóstica. Se revisó fichas clínicas y se especificó el tipo de cirugía junto con los hallazgos intra-quirúrgicos. Resultados: se observó erosión de la cadena osicular intraoperatoria en 75 pacientes, 63 predichos correctamente por tomografía computada (TC), con sensibilidad del 84% y especificidad del 94% (k = 0,625). Se detectó erosión del tegmen tympani en nueve pacientes por TC de los 10, con un VPP = 90% y un VPN = 95% (k = 0,809). Hubo sospecha de erosión del canal semicircular lateral en cinco pacientes y se encontró dehiscencias intraoperatorias en 12, sin falsos positivos (k = 0,554). La TC detectó dehiscencia del canal del nervio facial con sensibilidad del 55% y especificidad del 98% (k = 0,636). Conclusión: Los resultados sugieren que la TC preoperatoria con evidencia radiológica de erosión osicular tiene una buena a muy buena concordancia con los hallazgos intraoperatorios.


Introduction: There is a great controversy about the radiological signs of middle ear pathology and its relation with the real extension of the pathology that suggests us to decide a certain medical choice. Aim: To establish concordance between radiological and surgical findings in patients submitted to mastoidectomy. Material and Method: An observational and descriptive design of retrospective cross-sectional diagnostic test. Clinical records were reviewed to specify the type of surgery and intraoperative findings. Results: Intraoperative ossicular chain erosion was observed in 75 patients, 63 were correctly predicted by computed tomography (CT), with a sensitivity of 84% and specificity of 94% (k = 0.625). Tegmen tympani erosion was detected by CT in 9 patients out of 10, with a PPV = 90% and NPV = 95% (k = 0.809). There was suspected lateral semicircular canal erosion in 5 patients and intraoperative dehiscence was found in 12, with no false positives (k = 0.554). CT detected facial nerve canal dehiscence with sensitivity of 55% and specificity of 98% (k = 0.636). Conclusion: The results suggest that preoperative CT with radiological evidence of ossicular erosion has good to very good agreement with intraoperative findings.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Otite Média/cirurgia , Otite Média/diagnóstico por imagem , Mastoidectomia/métodos , Otite Média/epidemiologia , Paraguai/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Distribuição de Qui-Quadrado , Epidemiologia Descritiva , Orelha Média/patologia
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