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3.
J Int Adv Otol ; 17(4): 368-371, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34309560

RESUMO

A 61-year-old woman presented with diplopia and headache. The patient had a longstanding history of petrous bone cholesteatoma (PBC) on the left side and had undergone multiple surgeries to address it. Computed tomography (CT) revealed a radiolucent lesion with bony destruction in the left petrous apex. Magnetic resonance imaging of the lesion revealed a hypointense area on T1-weighted images and a hyperintense area on T2-weighted and abnormal diffusion-weighted images. A diagnosis of recurrent petrous apex cholesteatoma was made. The patient was treated by exteriorization using an endoscopic endonasal approach. The patient is in remission and doing well. The ideal treatment of PBC is complete excision, though exteriorization using an endoscopic endonasal approach is considered a second option when excision is not possible.


Assuntos
Colesteatoma , Otopatias , Osso Petroso , Colesteatoma/cirurgia , Otopatias/diagnóstico por imagem , Endoscopia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Tomografia Computadorizada por Raios X
4.
Vestn Otorinolaringol ; 86(3): 127-133, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34269036

RESUMO

The report presents modern views on the origin and pathomorphological characteristics of the cholesterol granuloma of the petrous apex of temporal bone, its clinical comparison with congenital cholesteatoma of the same localization. The differential diagnostic features in CT and MRI scans are analyzed in detail, and the principles of surgical treatment, indications and contraindications are discussed. Also the case of atypical course of cholesterol granuloma is presented, which was difficult in the diagnostics but with a successful treatment result.


Assuntos
Colesteatoma , Tomografia Computadorizada por Raios X , Colesteatoma/diagnóstico , Colesteatoma/cirurgia , Colesterol , Granuloma , Humanos , Imageamento por Ressonância Magnética , Osso Petroso/cirurgia , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia
5.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011658

RESUMO

The following is a case report of an adolescent with mental retardation who had congenital aural atresia with contralateral congenital facial palsy. She developed multiple intracranial complications (cerebellar abscess and lateral sinus thrombosis) due to cholesteatoma. We managed her in a multidisciplinary approach. This report discusses case management, emphasising the meticulous intraoperative steps taken in identifying the landmarks and precautions adopted to avoid postoperative facial palsy and other complications.


Assuntos
Abscesso Encefálico , Doenças Cerebelares , Colesteatoma , Trombose do Seio Lateral , Otite Média , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Colesteatoma/complicações , Colesteatoma/diagnóstico por imagem , Colesteatoma/cirurgia , Feminino , Humanos , Trombose do Seio Lateral/diagnóstico por imagem , Trombose do Seio Lateral/etiologia , Otite Média/complicações , Estudos Retrospectivos
6.
Surg Radiol Anat ; 43(8): 1285-1290, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33609169

RESUMO

INTRODUCTION: The pneumatization of the different regions of the temporal bone is strictly related to the age and the degree of development of the mastoid and the middle ear. Petrous apex pneumatization is the last step of the development of the petrous bone system. The subcochlear canaliculus is an anatomical cavity, originating in the space between the fustis and the finiculus, and connecting the round window area to the petrous apex. The aim of the present article is analyzing the trend of development of the subcochlear canaliculus pneumatization, classified through CT scan examination, in different age subgroups. MATERIALS AND METHODS: We conducted a retrospective review of patients who underwent temporal bone CT scans between 2014 and 2019. Pediatric and adult patients were included and divided into different age subgroups. The subcochlear canaliculus was examined through coronal view scans at the level of the round window niche and classified into 3 different groups (A, B and C) according to the degree of pneumatization. RESULTS: A total of 270 Petrous bone CT scans was analyzed. The percentage of type A subcochlear canaliculus was significantly higher in the pediatric population if compared to the adult population (p = 0.001326). As far as type B subcochlear canaliculus is concerned, the difference between children and adults was not statistically significant (p = 0.2378). On the other hand, type C subcochlear canaliculus was predominant in the adult population (p = 0.000256). CONCLUSIONS: There is a constant increase in pneumatization of the subcochlear canaliculus from 0 to 19 years and then a progressive decrease. This discovery has relevant surgical implications and has to be borne in mind in particular for cholesteatoma surgery and cochlear implantation surgery in the age groups in which the subcochlear canaliculus is highly pneumatized.


Assuntos
Colesteatoma/cirurgia , Implante Coclear/métodos , Osso Petroso/anatomia & histologia , Janela da Cóclea/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Estudos Retrospectivos , Janela da Cóclea/diagnóstico por imagem , Janela da Cóclea/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Artigo em Chinês | MEDLINE | ID: mdl-33540978

RESUMO

Objective:To discuss the possible reasons for cholesteatoma recidivism after canal-wall-up mastoidectomy with tympanoplasty by analyzing clinical characteristics of patients. Methods:Data of 21 cases who suffered from cholesteatoma recidivism after canal-wall-up surgery were retrospectively reviewed, including preoperative examination, high resolution temporal bone CT, and intraoperative findings. Results:90.5%(19/21) cases had recurrent cholesteatoma with retraction pockets. Among 12 cases with previous operative notes, 66.7%(8/12) had extensive cholesteatoma which was not limited to attic in the original surgery. The intraoperative features of revision surgery in 21 patients including the destruction of reconstructive lateral attic wall and scutumwere found in 19.0%(4/21) cases, the head of malleus left in 19.0%(4/21) cases, the cholesteatoma found in hidden part in 14.3%(3/21) cases, the hadeustachian tube dysfunction in 38.1%(8/21)cases. the sclerotic mastoid in 42.9%(9/21) cases. hadanatomic variations of the temporal bone in 14.3%(3/21) cases and atresia of external auditory canal in 4.8%(1/21) cases. Conclusion:In this group of recidivism cases, most patients had extensive cholesteatoma, which may lead to excessive mucosa loss during lesion clearance, poor ventilation of tympanic isthmus after surgery, and promote the formation of retraction pocket. In addition, some cases had eustachian tube dysfunction, unstable reconstruction of attic lateral wall, and improper selection of the indications, which may also increase the risk of recurrence. Therefore, in order to reduce cholesteatoma recidivism after canal-wall-up surgery, attention should be paid to the striction of surgical indications, comprehensive preoperative evaluation, thorough clearance of lesions and firm reconstruction.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Mastoidectomia , Reincidência , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/cirurgia , Meato Acústico Externo , Humanos , Processo Mastoide/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Timpanoplastia
8.
Otol Neurotol ; 42(3): e311-e316, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555753

RESUMO

OBJECTIVE: To evaluate whether a combined translabyrinthine-transsphenoidal approach can be used to achieve adequate surgical resection of an extensive petrous bone cholesteatoma and create a debris drainage route for the residual cholesteatoma that is maintained long-term. PATIENT: A 71-year-old man with residual petrous temporal bone cholesteatoma that had spread extensively to the internal carotid artery and posterior cranial fossa. INTERVENTION: Surgical resection of the cholesteatoma via a translabyrinthine approach and creation of a debris drainage route into the nasopharynx via a transsphenoidal approach. MAIN OUTCOME MEASURES: Control of unresectable petrous temporal bone cholesteatoma and occurrence of cholesteatoma- or surgery-related complications. RESULTS: Although complete removal of the cholesteatoma was attempted via a translabyrinthine approach, this was not possible because the epithelium of the cholesteatoma was strongly attached to the internal carotid artery and posterior cranial fossa. A debris drainage route leading to the nasopharynx was created by drilling the clivus on the side of the lesion via a transsphenoidal approach. The patient has had no complications since surgery. The drainage route remains open, and the cholesteatoma has been controlled for 57 months. CONCLUSIONS: A markedly advanced petrous temporal bone cholesteatoma can be managed safety and reliably by combining a translabyrinthine approach with a transsphenoidal approach. Creation of a debris drainage route into the nasopharynx can prevent isolation of the cholesteatoma and mastoid cavity problems after surgery. This one-stage surgery may be a suitable method for keeping cholesteatoma under control in patients with unresectable petrous bone cholesteatoma.


Assuntos
Colesteatoma , Osso Petroso , Idoso , Colesteatoma/cirurgia , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/cirurgia , Humanos , Masculino , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia
9.
Oper Neurosurg (Hagerstown) ; 20(6): E434-E435, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33575736

RESUMO

This 59-yr-old man presented with headache, dizziness, diplopia, and right-side hearing impairment for years. The objective degree of hearing impairment was not available. Magnetic resonance imaging (MRI) showed a right petrous apex lesion centered behind the right petrous internal carotid artery and extending lateral to the medial aspect of the right internal auditory canal. A combined endoscopic endonasal and left contralateral transmaxillary (CTM) approach was performed, and gross-total resection was achieved. Peeling the cyst wall from the dura resulted in minor weeping. It was covered with a left-sided, vascularized nasoseptal flap. His dizziness and diplopia improved immediately after the surgery. Histopathology revealed an epidermoid cyst. In this surgical video, we demonstrate the key steps of the CTM approach for access to the petrous apex posterior to the petrous internal carotid artery (ICA). The patient gave informed consent for surgery and video recording.


Assuntos
Colesteatoma , Cirurgia Endoscópica por Orifício Natural , Colesteatoma/diagnóstico por imagem , Colesteatoma/cirurgia , Humanos , Masculino , Nariz , Osso Petroso/diagnóstico por imagem , Osso Petroso/cirurgia , Base do Crânio
10.
Eur Arch Otorhinolaryngol ; 278(4): 1283-1288, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33439340

RESUMO

BACKGROUND: 30° and 45° endoscopes are commonly used, but there are few reports about the use of 70° endoscopes for ear surgery. METHODS: The use of 70° endoscopes made it possible to resect cholesteatomas without removing extensive regions of the external ear canal, which facilitated reconstruction, as the areas that needed to be reconstructed were smaller. CONCLUSION: None of the 34 patients who underwent this procedure for pars flaccida cholesteatoma suffered recurrence. Therefore, we consider that the procedure is useful. A further study of the postoperative outcomes of this procedure should be conducted.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Procedimentos Cirúrgicos Otológicos , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/cirurgia , Meato Acústico Externo/cirurgia , Endoscópios , Humanos , Membrana Timpânica
11.
Laryngoscope ; 131(3): E882-E884, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32770806

RESUMO

We present a rare iatrogenic cholesteatoma of the neck in a ten year old male four years after tympanomastoidectomy, an entity that to our knowledge has not been published in the literature for over 30 years. Furthermore, we discuss the diagnostic uncertainty of typical magnetic resonance imaging protocols for pediatric neck lesions and the improved diagnostic specificity of diffusion weighted magnetic resonance imaging. En bloc surgical extirpation was performed. Laryngoscope, 131:E882-E884, 2021.


Assuntos
Colesteatoma/diagnóstico , Colesteatoma/etiologia , Mastoidectomia/efeitos adversos , Pescoço , Timpanoplastia/efeitos adversos , Criança , Colesteatoma/cirurgia , Imagem de Difusão por Ressonância Magnética , Humanos , Doença Iatrogênica , Masculino
12.
Otolaryngol Clin North Am ; 54(1): 111-123, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33153732

RESUMO

Congenital cholesteatoma is a rare, primarily pediatric disease that presents in otherwise healthy ears. Typically, this disease is found in a well-defined sac in the middle ear, making it particularly suited for removal through transcanal endoscopic ear surgery. This article reviews the ways in which endoscopy can be applied to the surgical management of congenital cholesteatoma and provides a guide based on congenital cholesteatoma stage and extent. Outcomes have shown similar rates of residual disease in total endoscopic ear surgery compared with operative microscopy.


Assuntos
Colesteatoma da Orelha Média/cirurgia , Endoscopia/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Criança , Colesteatoma/congênito , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/congênito , Humanos , Resultado do Tratamento
13.
Otolaryngol Clin North Am ; 54(1): 163-173, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33243373

RESUMO

Pathology of the lateral skull base poses a unique challenge for the surgeon. An intimate knowledge of the anatomy and the various approaches used for accessing pathology of the lateral skull base is critical. Three novel, minimally invasive, transcanal approaches for the management of lateral skull base pathology are described herein along with their respective indications, advantages, and disadvantages.


Assuntos
Orelha Interna , Endoscopia/métodos , Base do Crânio/cirurgia , Colesteatoma/cirurgia , Humanos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos
14.
Eur Arch Otorhinolaryngol ; 278(10): 3777-3787, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33336300

RESUMO

BACKGROUND: To compare cholesteatoma care internationally and to evaluate outcomes, ear surgeons must use the same terminology. However, a clear universal definition on how to describe the extension, destruction and accompanying morbidity caused by the cholesteatoma is lacking. The practical applicability by means of interrater agreement is assessed for the STAMCO and the ChOLE classification. METHODS: A total of 134 adult patients derived from the nationwide multicentre study in the Netherlands, entitled Dutch Cholesteatoma Data (DCD) were included. Retrospective analysis of 134 surgical reports according to the STAMCO and ChOLE classification for localisation/extension of the cholesteatoma, complication status and ossicular chain status. Both the percentage agreement and the interrater agreement were determined for each item of the classifications and interrater agreement was compared between the classifications as a whole. RESULTS: Differences in interrater agreement were found for both the localisation/extension of the cholesteatoma and ossicular chain status. STAMCO classification derived from the surgical report scored better on the localisation/extension of the cholesteatoma, whereas the ChOLE classification derived from the surgical report scored better on the status of the ossicular chain. In both classifications, complication status had a low agreement level but was also poorly registered in the surgical reports. CONCLUSION: Both STAMCO and ChOLE will be beneficial in uniform registration of cholesteatoma pathology in practice. Modifications proposed for both classifications may make them even more practical applicable in the future. A common denominator obtained from these two classifications may be incorporated in a standardised surgical report to facilitate evaluation which make outcomes transferable towards both classifications.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Adulto , Colesteatoma/diagnóstico , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/cirurgia , Ossículos da Orelha , Humanos , Países Baixos , Estudos Retrospectivos
15.
Am J Otolaryngol ; 42(1): 102794, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33130529

RESUMO

PURPOSE: Controversy exists regarding the ideal approach for repair of lateral skull base defects. Our goal is to report the outcomes following middle cranial fossa (MCF) mini-craniotomy combined with mastoidectomy for patients with superior semicircular canal dehiscence (SSCD), spontaneous cerebrospinal fluid (CSF) leak, and cholesteatoma. MATERIALS AND METHODS: A retrospective database from chart review was formed consisting of 97 patients who met surgical criteria: SSCD, spontaneous CSF leak, and cholesteatoma. Mini-craniotomy MCF approach (<4 × 2 cm in size) combined with mastoidectomy was performed. All patients were admitted directly to the ICU postoperatively. Multiple factors were assessed, including need for revision surgery, duration of surgery, length of post-operative stay, and hospital readmission. RESULTS: Average surgery time was 110 min with no intraoperative complications. The average length of hospitalization was 2 days with an average ICU stay of 1 day. There were no neurologic complications; however, there were 3 inpatient complications (3%) which included 1 patient (1%) that had wound breakdown and 2 patients (2%) that had severe post-operative vertigo. A total of 8 patients (8%) required revision surgery and these were primarily for SSCD. The 30-day readmission rate was 3%. CONCLUSION: In the current series, all patients that underwent mini-craniotomy MCF surgery combined with mastoidectomy had minimal complications, short surgical time, limited hospital stay, low revision surgery rate and few hospital readmissions. This combined approach offers superior visualization of lateral skull base defects without the morbidity and risk typically associated with traditional, extensive MCF surgery.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Colesteatoma/cirurgia , Fossa Craniana Média/cirurgia , Craniotomia/métodos , Mastoidectomia/métodos , Deiscência do Canal Semicircular/cirurgia , Canais Semicirculares/cirurgia , Base do Crânio/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Vestn Otorinolaringol ; 85(5): 103-105, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140945

RESUMO

The article describes the clinical case of the cholesteatoma of the temporal bone pyramid, leading to a massive destruction of the surrounding structures. Attention is drawn to the importance of timely diagnosis of this pathology with the use of objective visualization methods to select the optimal surgical approach, which allows to completely remove this formation.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Otite Média Supurativa , Colesteatoma/diagnóstico , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Humanos , Osso Temporal/diagnóstico por imagem , Osso Temporal/cirurgia
17.
Otol Neurotol ; 41(8): 1094-1101, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169950

RESUMO

BACKGROUND: To coordinate and align the content for registration of cholesteatoma care. METHODS: Systematic Delphi consensus procedure, consisting three rounds: two written sessions followed by a face-to-face meeting. Before this procedure, input on important patient outcomes was obtained. Consensus was defined as at least 80% agreement by participants. Hundred-thirty-six adult patients who had undergone cholesteatoma surgery and all ENT surgeons of the Dutch ENT Society were invited. The consensus rounds were attended by ENT surgeons with cholesteatoma surgery experience. Feasibility and acceptability of outcome measures and reporting agreements were assessed in round 1 by 150 ENT surgeons. In round 2 definitions were narrowed and context information to interpret outcome measure were questioned. In round 3, the results, amendments, and the open-ended points were discussed to reach agreement. RESULTS: Most important outcome measures are: 1) the presence or absence of a cholesteatoma in the first 5 years after surgical removal of cholesteatoma, 2) hearing level after surgical removal of cholesteatoma, and 3) the documented assessment of patient's complaints with a validated patient reported outcome measures questionnaire (PROM). Furthermore, consensus was reached on the registration of cholesteatoma type (residual/recurrent), localization of cholesteatoma, and reporting of the presence of cholesteatoma in the follow-up. CONCLUSION: Consensus was reached on the content and method of registration of cholesteatoma care based on patient's and ENT surgeons input. Three outcome measures were defined. National agreements on the method and content of registration will facilitate monitoring and feedback to the ENT surgeon about the cholesteatoma care.


Assuntos
Colesteatoma , Adulto , Colesteatoma/cirurgia , Consenso , Técnica Delfos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa
18.
Otol Neurotol ; 41(10): 1391-1396, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33003180

RESUMO

OBJECTIVE: Assess the utility and prognostic capabilities of the European Academy of Otology and Neurotology (EAONO) and Japanese Otological Society (JOS) cholesteatoma classification system, specifically for retraction pocket cholesteatoma. STUDY DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS: Adults and children with retraction pocket cholesteatoma. INTERVENTIONS: Primary and planned second-look tympanoplasty with mastoidectomy. MAIN OUTCOME MEASURES: Incidence of recurrent or residual cholesteatoma at planned second-look surgery. Independent variables of age, gender, size of canal defect, and mucosa status were assessed. Additionally, the cholesteatoma classification, stage, and extent according to the EAONO/JOS system were recorded during the primary surgery. RESULTS: A total of 125 cases were included. Twelve (9.6%) cases had recidivism over an average time of 7.5 months: the recurrence rate was 4% (n = 5), residual rate was 5% (n = 6), and one patient had both recurrent and residual disease (0.8%). Residual cholesteatoma occurred more frequently in children (p = 0.04, RR = 7.9 [1.0, 63.6]). Supratubal recess (S1) disease was associated with both recurrent cholesteatoma (p = 0.04, RR = 5.9 [1.3, 27.2]) and recidivism (p = 0.01, RR = 4.2 [1.5, 11.9]). Larger canal defects also showed an association with residual disease (p = 0.017). CONCLUSION: Younger patients and those with large ear canal defects tend to have residual disease at second-look surgery. Supratubal recess disease is also associated with recurrence. Despite the utility of the EAONO/JOS classification and staging system for cholesteatoma description and type, the prognostic value remains uncertain.


Assuntos
Colesteatoma da Orelha Média , Colesteatoma , Reincidência , Adulto , Criança , Colesteatoma/cirurgia , Colesteatoma da Orelha Média/epidemiologia , Colesteatoma da Orelha Média/cirurgia , Humanos , Recidiva Local de Neoplasia , Nigéria , Estudos Retrospectivos , Resultado do Tratamento , Timpanoplastia
19.
Sensors (Basel) ; 20(18)2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32957675

RESUMO

We develop a stereo-multispectral endoscopic prototype in which a filter-wheel is used for surgical guidance to remove cholesteatoma tissue in the middle ear. Cholesteatoma is a destructive proliferating tissue. The only treatment for this disease is surgery. Removal is a very demanding task, even for experienced surgeons. It is very difficult to distinguish between bone and cholesteatoma. In addition, it can even reoccur if not all tissue particles of the cholesteatoma are removed, which leads to undesirable follow-up operations. Therefore, we propose an image-based method that combines multispectral tissue classification and 3D reconstruction to identify all parts of the removed tissue and determine their metric dimensions intraoperatively. The designed multispectral filter-wheel 3D-endoscope prototype can switch between narrow-band spectral and broad-band white illumination, which is technically evaluated in terms of optical system properties. Further, it is tested and evaluated on three patients. The wavelengths 400 nm and 420 nm are identified as most suitable for the differentiation task. The stereoscopic image acquisition allows accurate 3D surface reconstruction of the enhanced image information. The first results are promising, as the cholesteatoma can be easily highlighted, correctly identified, and visualized as a true-to-scale 3D model showing the patient-specific anatomy.


Assuntos
Colesteatoma , Colesteatoma/cirurgia , Endoscópios , Endoscopia , Humanos
20.
Acta Otolaryngol ; 140(11): 919-924, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32804559

RESUMO

BACKGROUND: Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial. OBJECTIVES: To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years. MATERIAL AND METHODS: Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments. RESULTS: Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26-48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0-0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02-1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01-0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44-0.93). CONCLUSIONS AND SIGNIFICANCE: Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.


Assuntos
Abscesso Encefálico/cirurgia , Procedimentos Neurocirúrgicos , Otite Média/complicações , Procedimentos Cirúrgicos Otológicos , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Abscesso Encefálico/mortalidade , Criança , Colesteatoma/complicações , Colesteatoma/cirurgia , Terapia Combinada , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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