Clinimetric evaluation and clinical outcomes of the Dutch version of the Chronic Ear Survey.

BACKGROUND: To validate and evaluate the reliability of the Dutch version of the Chronic Ear Survey (CES) in patients suffering from Chronic Suppurative Otitis Media (CSOM) and to evaluate clinical outcomes of surgery using this questionnaire. METHODS: We developed the Dutch version of the CES (D-CES) using forward-backward translation of the original CES into the Dutch language. Next, patients with CSOM and controls completed the D-CES pre- and postoperatively. Internal consistency, test-retest reliability, known-group validity and convergent validity were evaluated. In addition to the D-CES, the Short Form 36 (SF-36) was administered to all participants to correlate D-CES data to quality of life. RESULTS: A total of 29 patients with CSOM scheduled for ear surgery were included. Our control group consisted of 26 patients scheduled for eye surgery, all without signs and symptoms of CSOM. Cronbachs' α of the complete questionnaire was 0.69. The Intraclass Correlation Coefficients (ICCs), reflecting test-retest reliability, ranged between 0.69 and 0.82. Scores differed significantly between CSOM patients and controls with substantial lower (more impaired) D-CES scores in the CSOM group. Duration of complaints preoperatively and the presence of a dry ear and/or improvement of hearing postoperatively all had a significant impact on D-CES improvement scores. Small to moderate correlations were found between D-CES subscales and matching subscales of the SF-36. CONCLUSION: The D-CES is an appropriate disease specific questionnaire to assess a patient's perceived functional health in CSOM.

Management of labyrinthine fistula: hearing preservation versus prevention of residual disease.

The objective of the study was to evaluate postoperative hearing and disease control after cholesteatoma surgery for labyrinthine fistulas. In a retrospective cohort study, we evaluated a consecutive cohort comprising 44 patients (45 ears) with labyrinthine fistulas associated with chronic otitis media with cholesteatoma who underwent surgery between 2002 and 2015. We looked at patient characteristics, pre- and postoperative bone conduction thresholds (BCT), operative approach and findings, extent of disease and the occurrence of residual disease. All deaf ears (24%) presented preoperatively with a large fistula. Opening the membranous labyrinth resulted in significantly worse postoperative BCT (p = 0.01). Neither the present study nor a literature search revealed a significant positive effect of corticosteroids on postoperative hearing preservation. Large fistulas were correlated with poorer preoperative BCTs, but not with poorer postoperative BCTs. Opening the membranous labyrinth during surgery is correlated with poorer postoperative BCTs and can be seen as a predictive parameter. The use of corticosteroids in the perioperative management of labyrinthine fistula was not found to result in any improvement in postoperative BCTs.

Successful obliteration of troublesome and chronically draining cavities.

OBJECTIVE: This study aimed to evaluate the results of revision radical cavity surgery with mastoid obliteration using a standardised grading scheme. METHODS: A retrospective study was performed of 121 patients (122 ears) with chronically draining ears who underwent revision radical cavity surgery with mastoid obliteration between 2007 and 2013. Surgical indications, patient characteristics, pre- and post-operative Merchant grade, and surgical outcomes were recorded. The main outcome measures were presence of a dry ear, time for complete re-epithelialisation, presence of residual or recurrent disease, and need for revision surgery. RESULTS: In the 5-year follow-up group (n = 31), dry ears were found in 97 per cent after 6 minor revisions and cholesteatoma-free ears were found in 97 per cent. In the total cohort, dry ears were found in 93 per cent after nine revisions and cholesteatoma-free ears were found in 98 per cent. The median time for complete re-epithelialisation was eight weeks. There were no major complications. CONCLUSION: In terms of the dry ear rate, residual cholesteatoma and time to complete epithelialisation, revision radical cavity surgery with mastoid obliteration produces very good results in concordance with published results, despite most patients suffering from very troublesome cavities prior to surgery.