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Objective: Malignant otitis externa (MOE) is typically managed with long-term broad-spectrum antibiotics. The impact of surgical intervention on clinical outcomes is not well described. This study aims to compare clinical outcomes of MOE patients managed with or without surgery., Study Design/setting: Retrospective cohort, academic tertiary referral center., Methods: Patients diagnosed with MOE between January 2010 to September 2022 were included. Univariate analyses compared symptoms at initial presentation and long-term (≥1 year) outcomes between surgical and non-surgical patients., Results: A total of 23 patients were included (78% male, mean age 69 ± 13 years, median follow-up 305 days). Most ( N  = 22, 96%) patients were diabetic. Seventeen (74%) underwent surgical intervention (76% tympanomastoidectomy, 24% external auditory canal debridement and biopsy). Poor facial nerve (FN) function at initial presentation (defined as House-Brackmann [HB] grade ≥3) significantly predicted undergoing surgical intervention ( p  = 0.02). Comparing surgically managed versus non-surgical patients at the time of presentation, there were no differences in the degree of hearing loss, severity of diabetes, rate of insulin dependence, incidence of immunosuppression, or the Charlson Comorbidity Index (all p  > 0.05). FN outcomes at long-term follow-up also did not significantly differ (p > 0.05). No significant differences in the length of stay (9 vs. 6 days, p  = 0.2), rate of readmission (31% vs. 17%, p  = 0.5) or 5-year overall survival (53% vs. 66%, p  = 0.6) were observed between surgical and non-surgical patients., Conclusions: Long-term outcomes for patients with MOE remain poor. Patients with poor FN function at presentation were more likely to undergo surgical intervention. Patient comorbidities, including the severity of diabetes, were not predictive of undergoing surgery. However, surgical intervention for MOE did not appear to lower the length of stay, the rate of hospital readmission, or overall mortality in our cohort., Level of Evidence: III., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objective: Bioengineered tracheal grafts are a potential solution for the repair of long-segment tracheal defects. A recent advancement is partially decellularized tracheal grafts (PDTGs) which enable regeneration of host epithelium and retain viable donor chondrocytes for hypothesized benefits to mechanical properties. We propose a novel and tunable 3D-printed bioreactor for creating large animal PDTG that brings this technology closer to the bedside., Methods: Conventional agitated immersion with surfactant and enzymatic activity was used to partially decellularize New Zealand white rabbit ( Oryctolagus cuniculus ) tracheal segments ( n  = 3). In parallel, tracheal segments ( n  = 3) were decellularized in the bioreactor with continuous extraluminal flow of medium and alternating intraluminal flow of surfactant and medium. Unprocessed tracheal segments ( n  = 3) were also collected as a control. The grafts were assessed using the H&E stain, tissue DNA content, live/dead assay, Masson's trichrome stain, and mechanical testing., Results: Conventional processing required 10 h to achieve decellularization of the epithelium and submucosa with poor chondrocyte viability and mechanical strength. Using the bioreactor reduced processing time by 6 h and resulted in chondrocyte viability and mechanical strength similar to that of native trachea., Conclusion: Large animal PDTG created using our novel 3D printed bioreactor is a promising approach to efficiently produce tracheal grafts. The bioreactor offers flexibility and adjustability favorable to creating PDTG for clinical research and use. Future research includes optimizing flow conditions and transplantation to assess post-implant regeneration and mechanical properties., Level of Evidence: NA., Competing Interests: A provisional patent application titled “Modular Adjustable Bioreactor for Decellularization and Cell Seeding” is described in US Provisional Application No. 63/384028 filed in the United States Patent and Trademark Office on November 16, 2022. Tendy Chiang, Woo Yul Byun, and Lumei Liu share equal inventorship., (© 2024 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)