Inter and Intraobserver Agreement of the IOOG SAMEO ATO Classification for Tympanomastoid Surgery.

INTRODUCTION: In 2018 the International Otology Outcome Group (IOOG) introduced the stage of surgery, approach, mastoidectomy, external ear canal reconstruction, obliteration of mastoid cavity, access to middle ear, tympanic membrane, ossicular chain (SAMEO ATO) categorization framework for tympanomastoid surgery to develop a classification system that encompasses all aspects of surgical technique that are likely to influence the outcome of tympanomastoid surgery. To date there is no study that examines inter or intraobserver reliability of this classification system. OBJECTIVE: To assess inter and intraobserver reliability of the SAMEO ATO classification. STUDY DESIGN AND SETTING: Retrospective single center study. INTERVENTION: Two observers independently categorized 167 tympanomastoid surgeries using the SAMEO-ATO system to allow for interobserver analysis. Categorization was performed retrospectively from operation notes. Intraobserver reliability was evaluated for one observer. PATIENTS: One hundred sixty seven tympanomastoid surgeries performed by a single surgeon between 2018 and 2021. MAIN OUTCOME MEASURE: Inter and intraobserver reliability calculated using Cohen's kappa. RESULTS: Almost perfect interobserver agreement was seen for stage of surgery ( S ), approach ( A ), mastoidectomy ( M ), and ossicular chain ( O ) with kappa scores ranging from of 0.957 to 0.848.Almost perfect intraobserver agreement was seen for approach ( A ), mastoidectomy ( M ), external ear reconstruction ( E ), obliteration of mastoid cavity ( O ), access to middle ear ( A ), and ossicular chain ( O ) with kappa ranging from 0.929 to 08.21. CONCLUSION: The SAMEO ATO classification is a reliable system for recording surgical procedures. Given the complexity of the SAMEO ATO classification it is vital that those using it have a thorough knowledge of the classification.

A Tried and Tested Waterproof Draping Method for Major Ear Surgery.

Preparing and maintaining a clean operative field is the standard of care in all surgical fields globally. Major ear surgery has its own challenges such as the long surgical procedure time and the tricky local anatomical landscape. A waterproof method of draping for major ear surgery is described in this technical report. This method allows for the collection of irrigation fluid in a reservoir while maintaining continued isolation of the operative field during surgery. We discuss the advantages of using a 3M Steri-DrapeTM Aperture Pouch Drape to square the surgical site and create a pouch dedicated to irrigation fluid. Following that, running locking stitches are performed for further reinforcement of the adhesion to the skin, often done in longer procedures. We have identified a technique to ensure better draping. In over 150 cases draped in this method, we have not witnessed drape edge lift, water ingress, or skin avulsion/injury.

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation.

PURPOSE: To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation. METHODS: A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded. Ears were packed using one of two distinct methods. Pack A: gelatin sponge, chloramphenicol ointment and an antibiotic-soaked ear wick. Pack B: antibiotic-soaked gelatin sponge, bismuth iodoform paraffin paste (BIPP) impregnated gauze dressing. The primary outcome measure was post-operative complications associated with each packing method RESULTS: One hundred and fifty-three tympanoplasties were performed during this period: 68 underwent Pack A and 85 underwent Pack B. Chi squared test showed no significant association between pack type and complication rate (p = 0.572). Univariate analysis suggested that age (p = 0.047) and concurrent bony canaloplasty (p = 0.006) significantly increased complication rates. Pre-operative ear status, indication, graft type and gender did not affect complication rate. CONCLUSIONS: BIPP-impregnated ribbon gauze and chloramphenicol/wick are both comparable methods for packing an ear following tympanoplasty for tympanic membrane perforation. This is useful information both for surgeons who commonly use BIPP and have a patient with a known iodine allergy, or who is not known to be allergic to iodine but has been packed with BIPP previously, and for those who do not have access to BIPP and wish to use a pack with comparable success.

Mastoid surgery under local anesthesia for medically unfit patients: techniques and outcome.

OBJECTIVES: We present the surgical techniques and outcomes of mastoid surgery under local anesthesia in patients who were unfit for general anesthesia. METHODS: Five tertiary-referred patients with multiple comorbidities and failed conservative treatment for chronic otitis media were operated on under local anesthesia. No sedation was administered. The principles of cholesteatoma surgery were observed, but the technique was adapted to keep surgical time to a minimum. RESULTS: None of the patients had perioperative problems, and all have dry, waterproof ears with preservation of hearing after surgery. So far, none of the patients have had recurrent or residual disease. CONCLUSIONS: Cholesteatoma surgery can be successfully performed with a local anesthetic in patients who are medically unfit for general anesthesia. Surgery requires a good coordination of the operating team in order to shorten the operating time. Otologists should develop and maintain their skills by performing ear surgery with local anesthetic on a regular basis.

Harmonic scalpel tonsillectomy: a systematic review of evidence for postoperative hemorrhage.

OBJECTIVE: To systematically review the literature on harmonic scalpel tonsillectomy with a view of comparing its postoperative hemorrhagic rate with the conventional methods for tonsillectomy. DATA SOURCES: Cochrane Library, Medline, Embase, CINAHL, INAHTA, CRD (Centre for Review and Dissemination, York, UK), and related databases. The date of the last search was September 19, 2006; papers were considered irrespective of language of publication. REVIEW METHODS: Inclusion and exclusion criteria were applied independently by two reviewers with a third reviewer available for adjudication. The papers were quality assessed using Chalmers' criteria. Eleven randomized controlled trials (RCT) were included in the final review with five RCTs comparing harmonic scalpel tonsillectomy with "cold steel" tonsillectomy and six RCTs comparing harmonic scalpel with "hot" tonsillectomy techniques. RESULTS: All studies were underpowered to detect a significant difference in the postoperative hemorrhagic complication between harmonic scalpel and the comparator tonsillectomy techniques. The heterogeneity of studies made quantitative combination of results impossible. CONCLUSION: The evidence reviewed is of low quality and does not support any significant difference in postoperative hemorrhage rates when harmonic scalpel is compared with other tonsillectomy techniques. As studies have numerous methodological flaws and incorporate biases and confounding factors, these results need to be interpreted with caution. Larger and better-conducted studies would be needed in order to compare the safety of harmonic against conventional tonsillectomy methods. The need for a large sample size might make an RCT impractical; therefore a large, well-controlled cohort study could be more suitable.

A longitudinal study on pediatric myringoplasty.

OBJECTIVES: Observational study on pediatric myringoplasty to examine the success rate in young and older children. PATIENTS AND INTERVENTION: Fifty-one first-time primary myringoplasties were analyzed on children aged 4 to 13 years. MAIN OUTCOME MEASURES: Using life-table analysis, the survival course of the graft in young children (aged 4-8 yr) was compared with those in older children (aged 9-13 yr). The effect of age on various outcome parameters, including otitis media with effusion/atelectasis, discharge, and hearing, was analyzed using the 12-month data. RESULTS: The 3-year graft take rate was 83.8% (95% confidence interval: 70.2, 97.5%). At 12 months, only 63.0% (42.4, 80.6%) were free of otitis media with effusion/atelectasis and discharge and preserved their hearing. There is no evidence of a difference in outcome in young and older children. CONCLUSION: There was no evidence that age influenced surgical outcome in pediatric myringoplasty. Although the graft take rate was more than 80%, true success was only found in two thirds of cases.