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Abstract Introduction: Residual disease after cholesteatoma removal is still a challenge for the otorhinolaryngologist. Scheduled "second-look" surgery and, more recently, radiological screenings are used to identify residual cholesteatoma as early as possible. However, these procedures are cost-intensive and are accompanied by discomfort and risks for the patient. Objective: To identify anamnestic, clinical, and surgery-related risk factors for residual cholesteatoma. Methods: The charts of 108 patients, including children as well as adults, having undergone a second-look or revision surgery after initial cholesteatoma removal at a tertiary referral hospital, were analyzed retrospectively. Results: Gender, age, mastoid pneumatization, prior ventilation tube insertion, congenital cholesteatoma, erosion of ossicles, atticotomy, resection of chorda tympani, different reconstruction materials, and postoperative otorrhea did not emerge as statistically significant risk factors for residual disease. However, prior adenoid removal, cholesteatoma growth to the sinus tympani and to the antrum and mastoid, canal-wall-up 2 ways approach, and postoperative retraction and perforation were associated with a statistically higher rate of residual disease. A type A tympanogram as well as canal-wall-down plus reconstruction 2 ways approach for extended epitympanic and for extended epitympanic and mesotympanic cholesteatomas were associated with statistically lower rates of residual disease. A score including the postoperative retraction or perforation of the tympanic membrane, the quality of the postoperative tympanogram and the intraoperative extension of the cholesteatoma to the sinus tympani and/or the antrum was elaborated and proved to be suitable for predicting residual cholesteatoma with acceptable sensitivity and high specificity. Conclusion: Cholesteatoma extension to the sinus tympani, antrum and mastoid makes a residual disease more likely. The canal-wall-down plus reconstruction 2 ways approach seems safe with similar rates of residual cholesteatoma and without the known disadvantages of canal-wall-down surgery. The described score can be useful for identifying patients who need a postoperative radiological control and a second-look surgery.
Resumo Introdução: A doença residual após a remoção do colesteatoma ainda é um desafio para o otorrinolaringologista. A cirurgia revisional programada e, mais recentemente, exames radiológicos são usados para identificar o colesteatoma residual o mais precocemente possível. Entretanto, esses procedimentos são dispendiosos e acompanhados de desconforto e riscos para o paciente. Objetivo: Identificar fatores de risco anamnésicos, clínicos e relacionados à cirurgia para o colesteatoma residual. Método: Foram analisados retrospectivamente os prontuários de 108 pacientes, crianças e adultos, que passaram por revisão cirúrgica após a remoção inicial do colesteatoma em um hospital terciário de referência. Resultados: Sexo, idade, pneumatização da mastoide, inserção anterior de tubo de ventilação, colesteatoma congênito, erosão dos ossículos, aticotomia, ressecção da corda do tímpano, diferentes materiais de reconstrução e otorreia pós-operatória não se mostraram fatores de risco estatisticamente significantes para a ocorrência de doença residual. Entretanto, remoção prévia da adenoide, crescimento do colesteatoma para o interior do seio timpânico e para o antro e a mastoide, abordagem de duas vias com canal wall-up e retração e perfuração pós-operatórias foram associados a uma taxa estatisticamente maior de doença residual. Um timpanograma tipo A, assim como a reconstrução de duas vias com a abordagem canal wall-down para colesteatomas com extensão para o recesso epitimpânico e/ou extensão epitimpânica e mesotimpânica, foram associados com taxas estatisticamente menores da doença residual. Um escore, que incluiu a retração ou perfuração pós-operatória da membrana timpânica, a qualidade do timpanograma pós-operatório e a extensão intraoperatória do colesteatoma para o seio timpânico e/ou antro, foi elaborado e se mostrou adequado para predizer colesteatoma residual com sensibilidade aceitável e alta especificidade. Conclusão: A extensão do colesteatoma para o seio timpânico, antro e mastoide torna a doença residual mais provável. A abordagem do tipo canal wall-down mais a reconstrução de 2 vias parecem seguras com taxas semelhantes de colesteatoma residual e sem as desvantagens conhecidas da cirurgia do tipo canal wall-down. O escore descrito pode ser útil para identificar pacientes que necessitam de controle radiológico pós-operatório e cirurgia revisional.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Cholesteatoma, Middle Ear/surgery , Recurrence , Reoperation , Retrospective Studies , Risk Factors , Follow-Up Studies , Treatment OutcomeABSTRACT
Chronic Suppurative Otitis Media(CSOM) is long standing infection of mucoperiosteal lining of middle ear cleft. CSOM is classified into Tubotympanic or Safe and Atticoantral or Unsafe type. Atticoantral type involves the pars flaccida and is characterized by formation of a retraction pocket in which keratin accumulates to produce cholesteatoma. Mainstay of the management of atticoantral disease is surgery of mastoid and middle ear. Majority of otolaryngologists find the Canal wall down , open cavity operation with wide access to be the safest and simplest means of managing middle ear cholesteatoma. In present study , results of complete exenteration of mastoid air cell tracts underlying cholesteatoma with canal wall down mastoidectomy are studied.
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Objective To investigate the clinical effects of autologous mastoid cortex in canal wall -down tympanoplasty .Methods From Jun 2015 to Jan 2016 ,40 patients with chronic suppurative otitis media were ran-domly divided into the experimental group and control group ,with 20 patients in each group .Patients in the experi-mental group were treated with autologous cortical bone on the tympanic cavity reconstruction surgery + opening tympanoplasty + mastoid cavity filling surgery ,the control group received opening tympanoplasty only .All cases were followed up for 1 year to compare postoperative dry ear and hearing improvement in the two groups .Results The dry ear rate of the experimental group was (100％ ) higher than that of the control group (70％ ) .The hearing of the two groups was significantly improved(23 .42 ± 0 .90 dB) in the experimental group ,higher than that in the control group (8 .43 ± 0 .04 dB) at 6 months after operation .Conclusion Using autologous cortical bone on the tympanic cavity reconstruction in the treatment of chronic suppurative otitis media is effective .The postoperative dry ear rate is high and the hearing improvement is excellent .
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Introduction: In the surgical management of cholesteatoma, one can opt for a closed technique (simple mastoidectomy) or open surgery (radical mastoidectomy). Open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery combines the advantages of both techniques, namely, adequate surgical exposure, eradication of cholesteatoma, and anatomical reconstruction of the middle ear structures. Objective: To evaluate the surgical results in the management of cholesteatoma through the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery. Methods: Prospective analytical observational study conducted between 2009 and 2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle [University Hospital of Valle], performing preoperative clinical monitoring and quarterly postoperative tomography with previous assessments of hearing and pre- and postoperative audiometry. Results: Forty-five patients were studied. Mean postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15). Residual cholesteatoma was present in 6.6% of cases; three to four times lower than the rate reported in the literature. Conclusions: This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases.
Introducción: El manejo del colesteatoma es quirúrgico. Se puede optar por una técnica cerrada (mastoidectomía simple) o técnica abierta (mastoidectomía radical). La mastoidectomía abierta con reconstrucción de la pared posterosuperior y reconstrucción del oído medio en un solo tiempo quirúrgico reúne las bondades de ambas técnicas: una adecuada exposición quirúrgica, erradicación del colesteatoma y reconstrucción anatómica de las estructuras del oído medio. Objetivo: Evaluar los resultados quirúrgicos en el manejo del colesteatoma con la técnica de mastoidectomía abierta con reconstrucción de la pared posterosuperior y el oído medio en un solo tiempo quirúrgico. Métodos: Estudio analítico observacional prospectivo realizado entre 2009-2012 con pacientes sometidos a esta técnica quirúrgica en el Hospital Universitario del Valle, realizándose un seguimiento clínico preoperatorio y postoperatorio trimestral, y evaluaciones previas con tomografía de oído y audiometría pre y postoperatoria. Resultados: Se estudiaron 45 pacientes. La media de seguimiento postoperatorio fue de 28 meses. Se alcanzó éxito quirúrgico en el 93.3% de los pacientes medidos por el seguimiento clínico y radiológico. Se encontró preservación de la audición después de la reconstrucción del mecanismo auditivo, medido con audiometría basada en el promedio tonal auditivo, mediante la prueba estadística para muestras pareadas entre la PTA preoperatoria y postoperatoria (IC95% -1.47-12.15). Se presentó colesteatoma residual en el 6.6%, tres a cuatro veces menor al reportado en la literatura. Conclusion: Este tipo de cirugía se puede considerar una técnica exitosa en el tratamiento de colesteatoma en casos seleccionados.
Subject(s)
Adult , Female , Humans , Male , Cholesteatoma, Middle Ear/surgery , Mastoid/surgery , Plastic Surgery Procedures/methods , Audiometry , Colombia , Follow-Up Studies , Hearing , Prospective Studies , Treatment OutcomeABSTRACT
Introduction: Cholesteatoma is an aggressive disease and its management poses a greater challenge in children than in adults. This study reviews the experience of Universiti Kebangsaan Malaysia Medical Centre in the clinical presentation and management outcome of acquired cholesteatoma in paediatrics that required surgical interventions. Materials and Methods: A retrospective review of case records of patients below 18 years old who underwent surgery from 1999 to 2010. Results: A total of 46 patients presented with 53 cases of cholesteatoma in which seven patients had bilateral disease. The age of presentation ranged from four to 18 years old with a mean age of 12 years. Male and female patients were 65% and 35% respectively. Otorrhoea or previous history of otorrhoea on presentation was found in 94% and 96% of them had hearing impairment. Cerebellopontine angle abscess, sigmoid sinus thrombosis and mastoiditis were among the complications. Tympanic membrane was retracted in 64% while 47% having had attic retraction and 53% had total atelectasis. A majority (85%) underwent canal wall down surgery with or without tympanoplasty. Post-operatively, 71% had improvement or preserved hearing level. The duration of follow up ranged from one month to 13 years and a quarter had recurrent disease and underwent revision surgeries. Conclusion: Majority of the cholesteatoma patients suffered from hearing loss and otorrhoea. Tympanic membrane retraction remained the most common clinical finding. Hence, children with persistent otorrhoea after adequate treatment may represent cholesteatoma. Surgical options of canal wall up and canal wall down procedures have equal risk of recurrence.
Subject(s)
Cholesteatoma , Hearing Loss , RecurrenceABSTRACT
Objective: The main objective of this study is to assess the intraoperative finding during canal wall down mastoidectomy in paediatric patients undergoing surgery for unsafe type of chronic suppurative otitis media (CSOM) attending ENT OPD of Kathmandu Medical College. Materials and Methods: Fifty patients of age group 4 to 13 years who were suffering from unsafe type of CSOM with or without cholesteatoma were taken for the study. The study period was two years from April 2007 to March 2009. The operative findings like extent of cholesteatoma in different location of middle ear cleft, mastoid bony landmarks, and ossicular chain condition and otogenic complication were identified during canal wall down mastoidectomy. Result: Of the 50 patients 32 (64%) were boys and 18(36%) were girls. The age ranged from 4 years to 13 years. Majority of patients had cholesteatoma with granulation diseases (72%) followed by granulation diseases (16%). Involvement of disease in attic, aditus, antrum and mesotympanum were found to be high in majority of cases (82%) with high percentage of necrosis of incus (56%). Conclusion: The primary disease found in patients undergoing canal wall down mastoidectomy (CWDM) was cholesteatoma combined with granulation in72%, granulation in 16% and cholesteatoma in 12%.
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BACKGROUND AND OBJECTIVES: Hearing improvement after CWD tympanomastoidectomy is another major goal of surgery after eradication of disease, especially in cases with intact stapes. The objective of this study is to compare the postoperative results of hearing gain and middle ear condition according to the types of ossiculoplasty described above. SUBJECTS AND METHOD: Of patients who received CWD tympanomatoidectomy, 90 who had been followed up for more than 1 year after surgery were selected. We found 30 cases of classical tympanoplasty type III, 38 SC tympanoplasty cases, and 22 PORP tympanoplasty cases. Age and sex distribution, success rate of hearing improvement, mean of postoperative air-bone gap (ABG), rate of middle ear adhesion were analysed according to the type of surgery. RESULTS: At 3 months after surgery, success rates of hearing improvement were 37.0%, 51.4%, 57.1% for classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 25.1 dB, 19.4dB, 17.2 dB, respectively. Hearing results were statistically better in PORP tympanoplasty when compared with other groups (ANOVA with Duncan's multiple range test). At 1 year after surgery, success rates of hearing improvement were 21.1%, 35.5%, 64.7% in classical tympanoplasty type III, SC tympanoplasty, PORP tympanoplasty, respectively. Means of postoperative ABG in the above listed order were 29.1 dB, 20.3 dB, 16.7 dB, respectively. Hearing results were statistically better in PORP tympanoplasty compared with other groups (ANOVA with Duncan's multiple range test.). Rates of middle ear adhesion were 23.1%, 54.5% in classical tympanoplasty type III, tympanoplasty using strut, respectively. CONCLUSION: In cases with intact stapes in CWD tympanoplasty, we conclude that tympanoplasty using strut is more useful for hearing improvement and prevention of middle ear adhesion than classical tympanoplasty type III; for the strut material, we found PORP more effective than autologous materials.
Subject(s)
Humans , Ear, Middle , Hearing , Ossicular Prosthesis , Sex Distribution , Stapes , TympanoplastyABSTRACT
BACKGROUND AND OBJECTIVES: The canal wall down (CWD) precedure provides relatively safer access and lower recidivism rate compared to the canal wall up (CWU) procedure. Choice of initial surgical procedure and staging can be variable according to the surgeon's preference and experience. Aims of this study were to analyze the frequency and causes of reoperation and to analyze postoperative hearing results between two groups according to the status of stapes and staging. MATERIALS AND METHODS: Initial surgical management for 179 cases of cholesteatoma performed by 2 senior authors from 1993 through 1998 were reviewed retrospectively. RESULTS: CWD procedure was the preferred procedure (n=151, 84%) and surgery for hearing gain was performed in 103 cases regardless of staging. The numbers and causes of reoperation were analyzed. In CWD cases, the emergence of recidivism (i.e., residual or recurrent cholesteatoma) persisted during the follow up and annual rate of recidivism was around 2%. Between CWD and CWU group, there was no statistical difference in the annual incidence of recidivism. Hearing results according to the types of mastoidectomy and the status of stapes were analyzed at 1 year of the follow up. Air-bone gap closure (ABG closure) didn't show any differences in both groups. In both groups, there were no statistical differences in the ABG closure according to the status of stapes. CONCLUSION: Even though CWD surgery was mainly performed in extended and advanced cases, the rate of recidivism and postoperative hearing results showed no statistical differences between the two groups. A well-performed primary canal wall down surgery is safe with a few problems requiring no further procedure in cholesteatoma surgery.