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To report health utilization patterns and outcomes of medical and surgical management in patients with chronic suppurative otitis media (CSOM).Retrospective cohort.Academic otology clinic.This study included 175 patients with CSOM with a first clinic visit at our institution between March 2011 and November 2016. All patients displayed a diagnosis of CSOM byPatients had an average of 9.5 ± 0.5 otology visits, 4.7 ± 0.4 prescriptions, and 1.7 ± 0.1 surgeries, with estimated per patient cost ranging from $3927 to $20,776. Under medical management, 69% of patients displayed recurrence of disease, with a median time to recurrence of 4 months. For tympanoplasty and tympanomastoidectomy, median time to recurrence was similar at 5 and 7 years, respectively (CSOM represents a major public health issue with high health care utilization and associated costs. Surgery is superior to medical therapy for achieving short- to medium-term inactive disease. Patients with CSOM display a high SNHL burden.

Background Mastoidectomy is one of the common surgical procedures performed by the otologist. It is commonly done for cholesteatomatous chronic otitis media (CCOM) and can be performed as either canal wall up or down techniques. Most of the CCOM is associated with ossicular erosions which require ossicular chain reconstruction (OCR) which can be done either in one stage or multiple stages. A multitude of factors affects postoperative OCR results with tympanomastoidectomy. Among various factors, the status of the tympanic membrane and middle ear mucosa is quite essential. To date, there are no randomized or prospective studies assessing the integrity of pars tensa and status of the middle ear mucosa in hearing outcomes in single-stage tympanomastoidectomy using partial ossicular replacement prosthesis (PORP) in the literature. Therefore, this study is performed to correlate the integrity of pars tensa and middle ear mucosa condition with postoperative hearing results of single-stage canal wall down (CWD) tympanomastoidectomy with PORP. Results Forty-two patients with cholesteatomatous chronic otitis media underwent single-stage canal wall down mastoidectomy (CWD) and partial ossicular replacement prosthesis (PORP) placement. The statistical analysis was done to compare the results of postoperative hearing with the intraoperative integrity of pars tensa and middle ear mucosa status. The mean pre- and postoperative air-bone gaps (ABGs) of all cases were 23.9 dB and 21 dB, respectively, with no statistically significant difference. In the pars tensa intact group, the mean pre- and postoperative ABGs were 21.5 dB and 18.5 dB, respectively, and in the pars tensa not intact group, the mean pre- and postoperative ABGs were 25.7 dB and 22.8 dB, respectively, and both groups had statistically insignificant difference. The pre- and postoperative ABGs in the healthy middle ear mucosa group were 20.7 dB and 19 dB, respectively. Similarly, the pre- and postoperative ABGs in non-healthy middle ear mucosa were 24.4 dB and 21.2 dB, respectively. The differences were not statistically significant in both groups. Conclusion There was a statistically significant improvement in postoperative air conduction threshold (ACT) in all cases. The integrity of pars tensa and middle ear mucosa status did not affect the postoperative hearing outcome in single-stage CWD tympanomastoidecomty using PORP.

To characterize postoperative pain after tympanoplasty and tympanomastoidectomy and correlate between pain severity and various technical aspects of the surgery. We carried out a prospective cohort study of patients undergoing ear surgery in a tertiary referral center between 7/2018 and 7/2019. Patients filled in a pain questionnaire and scored pain intensity on a visual analog scale preoperatively and on postoperative days (POD) 1–4, 21, and 49. The responses were correlated with clinical and operative data, including surgical technique-related details. Sixty-two patients participated in the study (27 males and 35 females, average age 41.1 ± 20.02 years [range 18–68]). The median preoperative VAS was 5, followed by 6 on POD1, 5 on POD3, and 1 at 3 and 9 weeks. The preoperative questionnaire score normalized to 10 was 4.5 (32/70), 5.1 on POD1, 4.7 on POD3, 0.85 at 3 weeks and 0.85 at 9 weeks. The predictive factors for increased postoperative pain were younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus. The predictive factors for decreased pain were smoking and the addition of a mastoidectomy. None of the factors related to the surgical technique (e.g., surgical approaches, type of reconstruction, specific surgeon) significantly affected the questionnaire responses or the pain VAS intensity scores. We demonstrated that younger age, the presence of a comorbidity, revision surgery, preoperative dizziness or tinnitus and postoperative tinnitus were predictors of increased pain after tympanoplasty and tympanomastoidectomy, while the inclusion of a mastoidectomy was a predictor of decreased pain.

Introduction The treatment of cholesteatoma is generally surgical, and the major obstacle is the high prevalence of recidivism. The endoscopic ear surgery technique is proposed to minimize this problem. Objectives To utilize endoscopes to visualize and manipulate cholesteatoma residues after microscopic removal Methods Cross-sectional study. Thirty-two patients with cholesteatoma underwent microscopic wall-up mastoidectomy combined with the endoscopic approach. The subjects were assessed for the presence and location of covert disease. Results Of the 32 cases, 17 (53.12%) had residual cholesteatoma in the endoscopic phase. Minimal disease was found, usually fragments of the cholesteatoma matrix. Pars tensa cholesteatomas had more covert disease than pars flaccida cholesteatomas (62.50% vs 43.75%). Posterior recesses (47.05%) and tegmen tympani (41.17%) were the locations with more covert disease (p Conclusion Cholesteatomas of the pars tensa presented more residual disease and were significantly more common in the posterior recesses and tegmen tympani.

A 39-year-old male with chronic hydrocephalus requiring biventricular shunts presented with progressive pneumocephalus over several years. He showed no improvement following ventriculoperitoneal (VP) shunt revision and anterior skull base repair for a sphenoid dehiscence. Imaging continued to show worsening pneumocephalus with air tracking along the right facial nerve from the geniculate ganglion to the internal auditory canal (IAC). The patient then underwent tympanomastoidectomy and skull base reconstruction. Based on a search of published literature, this appears to be the first reported case of temporal bone pneumocephalus coursing through the IAC, unlike most cases associated with tegmen defects and middle fossa pneumocephalus.

A glomus tympanicum with chronic infectious otorrhea should have a lower threshold for surgical exploration as an occult cholesteatoma may be present in a location difficult to diagnose without performing a tympanomastoidectomy.

Our study aimed to determine the accuracy of computed tomography (CT) scan by comparing the preoperative CT findings with the perioperative findings in patients with chronic otitis media (COM). In this study, preoperative CT evidence of 208 patients, who underwent tympanomastoidectomy for COM in Afyonkarahisar Health Sciences University, Otolaryngology Clinic between September 2009 and May 2018, were compared with their surgical findings. When we compared preoperative computed tomography findings with perioperative findings of patients; CT could determine cholesteatoma in mastoid and middle ear space with 74% sensitivity, 64% specificity, 85% positive predictive value (PPV) and 24% negative predictive value (NPV), respectively. Considering ossicular defect, CT could demonstrate the destruction of malleus with 83% sensitivity, 71% specificity, 67% PPV and 66% NPV, destruction of incus with 74% sensitivity, 87% specificity, 92% PPV and 40% NPV, destruction of stapes with 69% sensitivity, 52% specificity, 59% PPV and NPV 51%, respectively. In determining ossicular chain destruction in patients with cholesteatoma, we reached the conclusion that findings of ossicular chain destruction in CT could be judged in favor of cholesteatoma with values of 81% sensitivity, 75% specificity, 93% PPD and 48% NPV. As a result, despite limitations, radiological scanning of the temporal bone with CT is a reliable guide for surgical management of COM with an expert evaluation. [Med-Science 2020; 9(4.000): 907-11]

Background: For many years, Canal Wall Down (CWD) tympanomastoidectomy has been the gold standard for treatment of cholesteatoma; however, this method has long-term complications for the patients. The Intact Canal Wall (ICW) tympanomastoidectomy has relatively lower complications, but access to the middle-ear recesses is difficult in this method. Therefore, endoscopy is used to visualize the underexposed recesses. Objective: This study aims to compare the incidence of residual cholesteatoma using the two methods of CWD and endoscopic-assisted ICW. Materials and Methods: In this prospective randomized clinical trial, participants were 40 patients with cholesteatoma in the middle ear and mastoid who were candidates for tympanomastoidectomy. They were randomly divided into two groups. In the first group, ICW was performed with endoscopic assisted visualization, while in the second group, conventional CWD technique was performed without ossicular reconstruction. All the patients were microscopically examined at 3, 6, 9 and 12 months after surgery. Revision middle ear surgery and possible ossicular reconstruction under local anesthesia were performed one year after the surgery. The presence of cholesteatoma pearl in the middle-ear, evaluated by using a 2.7mm 30° endoscope, was recorded as the sign of residual cholesteatoma. Fisher’s exact test and Mann-Whitney U test were used for statistical analysis. Significance level for the tests was set at 5%. Results: The incidence of residual cholesteatoma was not statistically significant between the two groups (P>0.05). In each group, 20% (n=4) had residual cholesteatoma. The difference in time interval from the first to second surgery was not statistically significant between the study groups (P>0.05). Conclusion: Endoscopic-assisted ICW tympanomastoidectomy is comparable with CWD tympanomastoidectomy in eradication of cholesteatoma, having possibly fewer complications. It is recommended that more studies be conducted with a larger sample size and longer follow-up period.

Objective To analyze surgical outcomes of a novel alloplastic reconstruction technique for partial external auditory canal (EAC) defects in tympanomastoidectomy. Methods Retrospective study of 51 patients with cholesteatoma who underwent repair of partial EAC defects during tympanomastoidectomy at a tertiary referral center over 8 years. Nineteen patients were treated with a novel alloplastic graft technique using hydroxyapatite cement and bone pâté for EAC repair. Thirty‐two patients treated with traditional cartilage repair of the EAC served as a control group. The primary outcomes measured were postoperative cholesteatoma recurrence rates, infection rates, and mean air‐bone gap (ABG). Results Twenty of the 51 cases (39.2%) were revision surgeries for cholesteatoma recidivism, with a greater proportion of revision surgeries in the alloplastic group (57.9% vs 28.1%, P = .04). There was no significant difference in postoperative cholesteatoma recurrence (P = 1.00) or infection rates (P = .64) between the two techniques, with the alloplastic group experiencing slightly lower rates of recurrence (36.8%) and infection (5.3%) than cartilage repair (37.5% recurrence, 12.5% infection). Mean postoperative ABGs were comparable between the alloplastic (21.5 dB) and cartilage group (26.0 dB, P = .10). Conclusions Composite alloplastic and bone pâté reconstruction is an effective technique to repair partial EAC defects in tympanomastoidectomy, with comparable postoperative hearing outcomes and no increased risk of cholesteatoma recurrence or infection compared to traditional cartilage repair. Recidivism rates were relatively high in both groups, likely due to the high rate of revision surgeries and aggressive nature of cholesteatoma within the cohort. Level of Evidence Level 3B., A retrospective study was performed to evaluate the surgical outcomes of a novel alloplastic technique using hydroxyapatite cement and bone pâté to repair partial external auditory canal (EAC) defects in intact canal wall tympanomastoidectomy. The study demonstrated that this alloplastic technique provides a viable alternative to cartilage repair of the EAC, with comparable outcomes in regard to infection, cholesteatoma recurrence, and hearing results.

The primary head and neck myxomas are rare, generally arising from the mandible, maxilla, and oral cavity. Other anatomical areas, such as cardiac myxomas, may also have metastases to the head and neck regions. The middle ear is an extremely rare location for myxomas. Myxoma slowly grows and is usually asymptomatic until it affects the surrounding structures. Surgical treatment is performed with a complete en bloc resection where possible. We report a case of a 42-year-old woman with myxoma arising from the right middle ear because of her tumor’s rare anatomical region. Her main complaints were progressive fullness and loss of hearing which she felt for approximately 1 year on the right ear. High-resolution computed tomography (HRCT) revealed an isodense soft tissue mass localized in the right mastoid bone and the middle ear. The mass was totally removed by canal wall up tympanomastoidectomy. At the last follow-up examination on 36 months after the surgery, the patient was asymptomatic, and there were no signs of recurrence.

A middle-aged woman presented with two months of left ear pain and hearing loss. She had previously been admitted to an outside hospital for left-sided otomastoiditis and was treated with antibiotics without resolution. After failing outpatient management with pressure equalization tube placement and developing new neck pain, she was admitted to the hospital to rule out meningitis. Lumbar puncture was normal and the patient started on broad-spectrum intravenous antibiotics. Computed tomography and magnetic resonance imaging showed persistent fluid in the left middle ear and mastoid without bony erosion as well as a mass in the left nasopharynx and right parotid gland. The patient did not improve and was taken for biopsy of masses and left tympanomastoidectomy. Multiple blood and tissue samples were negative for infection or malignancy. Ultimately, autoimmune labs were obtained showing elevated cANCA and serine proteinase 3 (PR3), consistent with granulomatosis with polyangiitis and she improved with steroid treatment. This is the first report of GPA with focal simultaneous involvement of the nasopharynx and parotid, which made the diagnosis challenging to establish.

A symptomatic facial canal meningocele is a rare entity which poses a diagnostic dilemma for otologists, neurosurgeons and neuroradiologists. Computed tomography (CT) and magnetic resonance imaging (MRI) can assist with the diagnosis. Treatment options range from conservative management with interval imaging to surgical management, which must balance the risk of post-operative facial nerve paralysis. The preferred operative management in refractory meningitis cases, due to CSF leak, involves subtotal petrosectomy and blind sac closure. This report presents a case of child with a background of a Type 1 Arnold-Chiari malformation, who presented with a prolonged history over 8 years with presentations of recurrent meningitis, facial nerve palsy and unilateral sensorineural hearing loss. The unusual diagnosis of a facial nerve canal meningocele was made and subsequenently underwent a tympanomastoidectomy/subtotal petrosectomy and blind sac closure.

Objective Few reports discuss the characteristics of repeated recidivism of cholesteatoma. We describe the clinical characteristics of patients with cholesteatoma who experienced at least two recidivism episodes after initial surgery for cholesteatoma requiring canal wall reconstruction. Methods We reviewed the medical records of 11 patients who underwent surgery for cholesteatoma with canal wall reconstruction at our department between April 2008 and March 2018 and subsequently experienced two relapses that necessitated revision surgery involving tympanomastoidectomy with canal reconstruction. Patient age at the time of the first surgery ranged from 6 to 56 (mean, 25.7) years. Seven (63.6%) of the 11 patients were male. These 11 patients were classified according to the type of recidivism, and their characteristics (pathology, operation date, operation method, pattern of relapse, and position of recurrence) were investigated. Results Four cases involved secondary residual cholesteatoma, with the mean interval between the first revision surgery and the second revision surgery being 23.8 (range, 11–39) months. Secondary residual sites included the anterior tympanic cavity, tympanic sinus, and anterior end of the reconstructed cartilage of the canal wall. The other seven cases involved secondary recurrence, with the mean interval between the first and the second revision surgery being 26.1 (range, 12–57) months. The sites of recurrence were at the edges of the reconstructed cartilage. One notable case involved the cartilage junction, leading us to hypothesize that retraction of the temporal muscle flap and the patulous Eustachian tube was the underlying cause. Conclusion For residual cholesteatoma, strict measures are necessary to maintain the operation under clear view, and more careful follow-up is necessary in patients who have had previous surgery at another hospital. For recurrent cholesteatoma, it was recognized that Eustachian tube function must be ascertained in advance, and careful observation of the reconstructed cartilage edge is necessary.

Fungal balls consist of rounded conglomerates of fungal mycelia, which can form within a preexisting cavity. They are mostly found in the paranasal sinuses in the head and neck regions. Cholesterol granuloma is a fibrotic lesion that develops as a tissue response to a foreign body such as cholesterol crystals or hemosiderin and is often associated with chronic otitis media. We present the unusual case of a 62-year-old male who was treated for chronic otitis media, which was histologically confirmed as a fungal ball and cholesterol granuloma in the middle ear cavity following tympanomastoidectomy. This is the first reported case of synchronous fungal ball and cholesterol granuloma in the middle ear cavity.

Objective: To review current literature and experience with glomangiomas, or true glomus tumors of the middle ear and mastoid as well asto report on the exceptionally rare case of a glomangiomastemming from the middle ear space with multiple recurrences. Methods: Review of existing world literature and description of personal experience with rare cases of a glomangioma of the middle ear and mastoid. Results: Review of existing literature revealed two cases of patients presenting with tinnitus and hearing loss refractory to medical management. Both patients were ultimately diagnosed with glomangioma on histopathology. Complete surgical excision is thought to be curative. Patient: A 36-year-old woman presented with a rare case of a glomangioma of the middle ear presenting with unilateral hearing loss. She was noted to have a mass behind the tympanic membrane. Imaging revealed a diffuse mass filling the mastoid air cells. Imaging characteristics and histology were consistent with a glomangioma. Intervention: Initial resection via mastoidectomy using a postauricular approach. The tympanic membrane was reconstructed with temporalis tissue. Follow-up revision tympanomastoidectomy was performed upon recurrence of disease. The chorda tympani were sacrificed due to tumor involvement. The incus and head of the malleus were removed to gain better access to the tumor. The ossicular chain was reconstructed with a Goldenberg Total Ossicular Prosthesis. Main outcome measure: Recurrence of disease. Follow-up: In the 67 months since her most recent surgery, there has been no evidence of recurrence by CT or physical exam. Conclusion: Glomangioma of the middle ear represents an exceptionally rare entity that can present in a similar fashion to a paraganglioma. Keywords: Glomangioma, Glomus tumor, Glomuvenous malformation, Middle ear tumor, Unilateral hearing loss

Background Cholesteatoma is a destructive, erosive growth of keratinizing squamous epithelium in the middle ear cleft. Following treatment with a canal wall-up (CWU) tympanomastoidectomy, surveillance of residual and recurrent disease has traditionally been achieved through a second look tympanotomy following the initial procedure. Historically, MRI sequences have been inadequate at differentiating between granulation tissue, inflammation, and cholesteatoma. Recent literature has shown diffusion-weighted magnetic resonance imaging (DWMRI) to be a viable alternative to second look surgery for the detection of residual or recurrent disease. The goal of the present study was to perform a cost analysis of DWIMRI versus second look surgery in the detection of residual or recurrent cholesteatoma following combined approach tympanomastoidectomy. Methods A probabilistic decision tree model was generated from a literature review to compare traditional second look surgery with DWMRI. Cost inputs were obtained from the Ontario Case Costing Initiative, the Ontario Health Insurance Plan (OHIP) schedule of benefits. Costs were reported in Canadian dollars and a payer perspective was adopted. A probabilistic sensitivity analysis was performed. Results According to the probabilistic sensitivity analysis, mean cost difference of traditional second look tympanotomy versus echo planar imaging (EPI) DWMRI was $180.27CAD, 95%CI [$177.32, $188,32] in favour of second-look tympanotomy. However, mean cost difference of traditional second look tympanotomy versus non-EPI DWMRI was $390.66CAD, 95%CI [$381.52, $399.80] in favour of non-EPI DWMRI. Conclusions Diffusion-weighted MRI, specifically non-EPI sequences, are a viable cost-saving alternative to second-look tympanotomy in the setting of detecting residual or recurrent cholesteatoma.

The effect of ketofol, a mixture of ketamine and propofol in various ratios, on hemodynamic, for intubation without the use of neuromuscular blockers, has not been elucidated in patients undergoing tympanomastoidectomy. We evaluated the effects of ketofol and propofol on intubation conditions and hemodynamic without the use of a neuromuscular blocker. The prospective randomized, double-blinded study was scheduled for tympanoplasty or mastoidectomy. The patients were divided randomly into a propofol group (Group P) and a ketofol group (Group KP). Intubation conditions, changes in hemodynamics, HR, MAP, systolic arterial pressure (SAP), and SpO2 values were recorded before induction, after induction, after intubation, and at 3-min intervals during the first 30 min, 5-min intervals for the next 30 min, and 10-min intervals after that. In the intragroup evaluation, SAP, DAP, MAP and HR values were lower in both groups compared to the baseline values. Hemodynamic values were significantly lower in Group P than in Group KP after intubation compared to baseline. DAP at 12 and 18 min, DAP and MAP at 24 min, SAP, DAP and MAP at 27 min, and SAP and MAP at 30 min after the start of the operation were significantly lower in Group P than in Group KP. The need for ephedrine and the number of patients who required ephedrine were significantly lower in Group KP than in Group P. Ketofol provided appropriate intubation conditions similar to propofol, without the use of a neuromuscular blocker, and contributed to better hemodynamic conditions in patients undergoing tympanomastoidectomy. [Med-Science 2019; 8(2.000): 381-4]

Objectives:The aim of this study was to investigate the audiometric outcomes of tympanomastoidectomy in children with cholesteatoma and to evaluate factors that may affect outcomes.Methods:A retrospective cohort study was conducted. All pediatric patients diagnosed with cholesteatoma who underwent primary canal wall-up tympanomastoidectomy with or without ossicular reconstruction from 2009 to 2016 at a tertiary university-affiliated pediatric medical center were included. Pure tone average (PTA) and air-bone gap (ABG) at 0.5, 1, 2, and 4 kHz were compared before and after surgery.Results:The cohort included 100 children (104 tympanomastoidectomies) of mean age 10.35 ± 3.6 years. The mean duration of follow-up was 35.4 ± 24.1 months. At surgery, 22 patients (21.2%) had intact ossicular chains, and 82 (78.8%) had ossicular discontinuity. Fifty-three patients (51%) underwent ossicular reconstruction, either partial (34 patients [64.1%]) or total (19 patients [35.8%]). In comparison with preoperative audiometry, there was a statistically significant improvement in PTA-ABG at the first postoperative examination (27.5 ± 12.7 vs 21.1 ± 11.1 dB, P = .001) and at the end of follow-up (20.2 ± 12.7 dB, P = .003) . Overall, values of less than 20 dB were measured in 34% of patients preoperatively and 73% postoperatively. On subgroup analysis, in patients who underwent any ossicular reconstruction, PTA-ABG was significantly improved relative to the preoperative value (28.1 ± 14.7 dB) at both the first (19.1 ± 11.9 dB, P = .006) and last (22.4 ± 15.1 dB, P = .011) audiometry examinations.Conclusions:Hearing outcomes after pediatric cholesteatoma surgery are diverse and related to several factors. The authors found that ossicular reconstruction improves audiometric outcomes, and the changes remain stable over time.Level of Evidence:IIB

Objectives The aim of the present study was to investigate the prognostic factors for short-term hearing outcomes of ossiculoplasty for primary pars flaccida cholesteatoma according to the European Academy of Otology and Neurotology/Japanese Otological Society (EAONO/JOS) and 2015 JOS staging systems. Materials and methods A total of 34 patients with primary pars flaccida cholesteatoma who underwent one-stage tympanomastoidectomy with partial ossicular reconstruction using double cartilage block were included in the study. The postoperative pure-tone average air-bone gap (PTA-ABG) was calculated, and two criteria of successful hearing outcomes were defined as ≤10 and ≤20 dB. Patients were classified according to the EAONO/JOS and 2015 JOS staging systems. Cochran-Armitage test was used to statistically analyze staging, and Fisher's exact test was used to analyze other factors. Results Successful hearing outcome with postoperative PTA-ABG ≤10 and ≤20 dB occurred in 23.5% and 55.9% of cases, respectively. When postoperative PTA-ABG ≤20 dB was defined as successful, the success rate significantly decreased with increase in EAONO/JOS stage, and S0 pathological status of the stapes (no involvement) was a significantly favorable predictive factor. When postoperative PTA-ABG ≤10 dB was regarded as successful, the significantly favorable predictive factors were S0 pathological status of the stapes and development of mastoid cells with MC2-3 (better developed cells). Conclusion Favorable prognostic factors for hearing outcomes of tympanomastoidectomy with partial ossicular reconstruction for primary pars flaccida cholesteatoma were low stage following the EAONO/JOS staging system and no stapes involvement and better development of mastoid cells following the 2015 JOS staging system.

Introduction: Glomus tumors are rare benign lesions of the middle ear that are often associated with symptoms of progressive hearing loss and pulsatile tinnitus. Diagnosis is often delayed due to the slow growth of the tumor, and surgical resections of the mass are the mainstay treatment. Case Presentation: A 56-year-old Latin American female was admitted to the hospital with a year-long history of intermittent pulsatile buzzing noise, progressive hearing loss, pain and discharge of the left ear. High-resolution Computerized Tomography and Magnetic Resonance Imaging revealed evidence of an enhancing mass lesion, which extended into the external auditory canal. A tympanomastoidectomy was performed. Most of the mass was removed, but some remained because of massive bleeding. The patient received 3 months of radiation therapy after the tympanic paraganglioma was surgically removed. Conclusion: This case exposed the audiological findings, the location, and the extent of the tumor. Management options consist of radiation therapy and surgical management, depending on the size of the tumor. Early detection of glomus tumors is essential to prevent non-reversible complications.

Introduction Cholesteatoma is a benign tumoral lesion of squamous epithelial cells in middle ear that can exist as congenital or acquired forms. Presentation of cases A 35-year-old housewife presented to ENT clinic of a private hospital in Kabul, Afghanistan, with a complete facial nerve paralysis in the right side. In her antecedents, there is a tympanomastoidectomy due to chronic middle ear infection. First symptom was right side earache without any discharge. She started to notice a progressive nodule in the posterior-inferior side of her right ear. The patient was taken to the operating room. She underwent general anesthesia, an extensive cholesteatoma was removed, and a limited area of the fallopian canal in which facial nerve oedema or redness was evident. Post-operative House Brackmann grade was 1 on day 15 after the surgery. Discussion Cholesteatoma is primarily managed surgically and currently there is no suitable medical substitute treatment strategy for cholesteatoma. Hearing improvement, making the ear dry and total omission of cholesteatoma are primary goals of surgical interventions in cholesteatoma management. Conclusion Cholesteatoma after surgical manipulations of middle ear is a rare complication with notable morbidity that has been reported almost from all around the world but our patient is the first reported case of cholesteatoma formation after surgical management of COM from Afghanistan that presented with facial nerve paralysis and hear decline., Highlights • Although cholesteatoma is a benign tumoral lesion of middle ear it can cause serious morbidity. • Facial nerve paralysis after otologic surgical interventions should make physicians suspicious to cholesteatoma formation. • There is not any medical substitution for surgery in management of cholesteatoma.

OBJECTIVE To examine the projected healthcare costs of intact canal wall (ICW) and canal wall down (CWD) tympanomastoidectomy surgery and associated clinic follow-up visits in the management of chronic ear disease. STUDY DESIGN A review of literature was performed to analyze the cholesteatoma recidivism rates of ICW and CWD tympanomastoidectomy. Projected Medicare cost simulation applied to representative samples of patients undergoing otologic surgery and follow-up clinic appointments projected over 15 years with an annual 25% cholesteatoma recidivism rate. SETTING Tertiary academic center. PATIENTS Simulated patient population status postchronic ear surgery and representative follow-up clinic visits with or without in-office mastoid debridement procedures. INTERVENTIONS Therapeutic and rehabilitative. MAIN OUTCOME MEASURES Healthcare cost. RESULTS Simulation of cost for chronic ear surgery with follow-up visits produced a higher mean cost for the ICW group compared with the CWD group at year 1 ($9112.06 versus $4954.16). However, CWD patients accumulate cost over time due to routine mastoid debridements. The accumulated costs for the CWD group surpassed the ICW group at 12.54 (CI: 12.02-13.11) years. CONCLUSIONS Using a projected cost analysis model, intact canal wall tympanomastoidectomy incurs a larger upfront cost than the canal wall down technique. However, long-term mastoid cavity maintenance costs accumulate to surpass the intact canal wall group at 12.54 years.

Background This study was designed to evaluate the effect of mastoid cavity obliteration with bone chips and reconstruction of canal wall with tragal cartilage after canal wall down tympanomastoidectomy with cartilage ossiculoplasty in the same session. Sixty-three patients with cholesteatoma underwent the technique mentioned above; patients were followed for 1 year postoperative. Results No cavity problems, median preoperative air bone gap was 32.86 ± 6.24 db, while the median postoperative air bone gap was 21.67 ± 5.99 db. Conclusions Canal wall down mastoidectomy with obliteration of mastoid cavity is an effective option for the complete removal of cholesteatoma and same session cartilage ossiculoplasty is a viable option.

OBJECTIVE This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. METHODS A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n���=���22), combined (n���=���35) and microscope exclusive (n���=���46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected and persistence or recurrence of the disease assessed. RESULTS The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of -��6.02��dB HL (95% CI -��8.87 to -��3.16, p���

Postoperative temporal bone imaging after surgical procedures such as ossiculoplasty, tympanomastoidectomy, cochlear implantation, and vestibular schwannoma resection is often encountered in clinical neuroradiology practice. Less common otologic procedures can present diagnostic dilemmas, particularly if access to prior operative reports is not possible. Lack of familiarity with the less common surgical procedures and expected postoperative changes may render radiologic interpretation challenging. This review illustrates key imaging findings after surgery for Meniere disease, superior semicircular canal dehiscence, temporal encephalocele repairs, internal auditory canal decompression, active middle ear implants, jugular bulb and sigmoid sinus dehiscence repair, and petrous apicectomy.

Aims: To evaluate a group of patients undergoing surgery for chronic otitis media with reference to theprognostic value of middle ear risk index and other factors in predicting the anatomical and functionaloutcome of tympanomastoidectomy with tympanoplasty.Subjects: The study comprised of 90 patients suffering from chronic otitis media with or withoutcholesteatoma. Patients attending the Otorhinolaryngology out patients department were considered for thisstudy.Methods: The patients underwent tympanomastoidectomy with tympanoplasty in which mastoidectomyperformed was of either canal wall up or canal wall down technique. In cholesteatoma surgery, wheneverpossible a canal wall up procedure was performed. Myringoplasty was done using autologous temporalisfascia graft by underlay technique. Middle ear risk index [MERI] and other factors were evaluated for theiroutcome predictive role in patients undergoing tympanomastoidectomy with tympanoplasty.Results: Outcomes were evaluated in terms of tympanic membrane graft uptake and post operative meanaudiological gain. The Middle ear risk index was also found to be significant predictor ofthe outcome ofsurgery. The patients with mild MERI scores had significantly better prognosis than the patients with severMERI scores.Conclusion: The Anatomical and Functional outcome of tympanomastoidectomy with tympanoplasty isdiversely affected by the pathological and technical factors associated with disease and its management. Abetter understanding of these factors is helpful for better prognostication of the factors affecting the diseaseand in planning the surgical procedure.

Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI). Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery. Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery. The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria. Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P

Background: Chronic otitis media (COM) endures be an important health problem across the world. Unleashed usage of antibiotics caused development of resistant bacterial strains for infections such as COM as well. Useful antibiotics therapy should be selected according to especially susceptibility pattern of most common local organisms.Aim: The study was conducted from July 2018 to June 2019 in one referral otolaryngology surgical center in the south of Iran to determine the causative microorganisms, their antibiotic sensitivity pattern and occurrence of bacteremia in chronic otitis media patients undergoing tympanomastoidectomy.Patients and Methods: This study designed with eighty-seven samples from eighty- seven ears which were obtained from patients who suffer from chronic otitis media. aerobic culturing and antibiotic sensitivity testing were done with standard antibiotic discs using the National Committee for Clinical Laboratory Standards guidelines. Also, venous blood samples were taken before and after the operation for microbiological study. fun Chi-square test, t-test were used for the statistical analysis in this study.Results: No microorganisms were isolated from the preoperative and post-operative blood cultures. Out of 87 patients, microbiological culture was yielded from 51 specimens (58.6 %). Staphylococci coagulase negative (n=19, 37%) was the most common isolate followed by Staphylococci coagulase positive (n=12, 23%). Susceptibility pattern of Staphylococci spp. showed that almost 80% isolates were sensitive to Ciprofloxacin followed by almost 60% to Co-trimoxazole.Conclusion: Our results proposed that bacteremia might not happen after tympanomastoidectomy. Continuous investigation of susceptibility pattern can improve the success of treatment process for chronic otitis media.

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.

In recent decades, there has been an increase in the use of composite graft in the closure of the tympanic membrane perforation. The aim of this research is to know the change of tympanogram and audiogram presentation after tympanomastoidectomy surgery using musculus temporalis fascia profunda graft and composite graft. Experimental research was being conducted on 22 Otitis Media Suppurative Chronic patients without cholesteatoma such as 14 patients using musculus temporalis fascia profunda graft and 8 patients using composite graft. The Audiometric tests were being administered twice, before and after tympanomastoidectomy surgery, in other hand tympanometry test was being performed after surgery. Data analysis using independent-t test, paire-t test, and chi square test. The research has shown that the Pure Tone Audiometry post-surgeries were being found higher on composite graft (68,4) in comparison with musculus temporalis fascia profunda graft (55,1), but statistically non-significant (p>0,05). On the contrary, on fascia graft group was being found significantly higher 1,47 than amplitudo composite graft (0,87), statistically significant (p

Objective To further elucidate the role of balloon Eustachian tuboplasty (BET) in tympanoplasty, we conducted a study to compare the outcomes of tympanoplasty with and without BET for the treatment of chronic suppurative otitis media (CSOM) with obstructive Eustachian tube dysfunction (OETD). Study design Case control study. Setting Tertiary referral center. Patients A total of 70 ears diagnosed with CSOM (tubotympanic type) and OETD were included in this study. Thirty-five patients were prospectively enrolled for BET and tympanomastoidectomy between February 2018 and June 2019. Thirty-five control subjects were matched by sex and age and retrospectively enrolled for tympanomastoidectomy between July 2016 and January 2018. Interventions BET, tympanomastoidectomy. Main outcome measures The graft take rate, hearing levels, and Eustachian tube function test results. Results The graft take success rate was higher in the BET group (80.0%; 28/35) than in the control group (68.6%; 24/35). However, the difference was not statistically significant. The average air-bone gap (ABG) improvement was 10.93 ± 7.70 dB in the BET group and 7.11 ± 8.08 dB in the control group, with a statistically significant between-group difference (p = 0.033). Conclusions Our findings suggest that BET can objectively and subjectively improve the Eustachian tube function, with a slight but significant improvement in ABG despite the lack of a clinically significant improvement overall. However, it does not affect the graft take rate. In summary, BET could be used as an adjunctive procedure in the treatment of CSOM with OETD.

Objective To compare long-term hearing outcomes following ossiculoplasty with cartilage tympanoplasty with (M) and without (M) the malleus present. Study design Retrospective chart review. Setting Tertiary referral center. Patients One twenty-six patients (18-88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts from 1998 to 2012 with at least 5 years of documented postoperative follow-up. Main outcome measures Short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 d and 1 yr after surgery), long-term hearing results (PTA-ABG measured ≥5 yr after surgery), Ossiculoplasty Outcome Parameter Staging (OOPS) index, and complications. Results There were 46 patients in the M group and 80 in the M group. Preoperative PTA-ABG was 23.8 dB for M and 34.5 dB for M (p = 0.00001). Short-term postoperative PTA-ABG was 19.3 dB for M and 18.5 dB for M (p = 0.727). Long-term postoperative PTA-ABG was 18.2 dB for M and 19.6 dB for M (p = 0.500). The OOPS index was 4.11 and 6.41 for M and M, respectively, (p = 0.00001). Thirteen patients (10.3%) experienced complications. Conclusion Our data suggest that the malleus is not statistically significant with regard to its impact on final audiometric outcome following ossiculoplasty. This has implications in our clinic, particularly in our use of the OOPS index as a prognostic tool, and will likely lead to its revision. These data may further support the coupling theory of acoustic gain and weaken the catenary lever theory.

This study mainly focus on hearing loss pattern in CSOM patients undergoing tympanoplasty surgery or tympanomastoidectomy pre-operatively and analysis of the outcome of the surgery in terms of improvement in hearing (air-bone gap) after 3 months of the surgery. All patients of age 15–65 years reporting to ENT OPD with ear discharge and decreased hearing were screened with detailed history, clinical examination and microscopic examination.110 cases of tympanic membrane perforation who were fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy. Our study shows that postoperative air-bone gap closure is maximum for cortical mastoidectomy type I tympanoplasty (14.03 dB), followed with cortical mastoidectomy with type II (12.2 dB), Type I tympanoplasty (11 dB), cortical mastoidectomy with type III (7.72 dB). Procedures combined with modified radical mastoidectomy showed a very poor mean improvement in our study. It is very difficult to predict the results preoperatively because outcome will depend on extent of involvement of middle ear cleft by the disease process which can only be assessed intraoperatively.

Introduction The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging. Objective To describe management strategies for cholesteatoma diagnosis, surgical treatment, and post-operative management in children with Down syndrome. Methods Retrospective case series of 14 patients (17 total ears) with Down syndrome diagnosed with cholesteatoma over a 9-year period. Results A total of 14 patients with cholesteatoma (3 with bilateral disease) were analyzed. Thirteen ears (76.5%) had ≥2 tympanostomy tubes insertions prior to cholesteatoma diagnosis, and otorrhea and hearing loss were the most common presenting symptoms. Common pre-operative CT scan findings included mastoid sclerosis and ossicular erosion. The average age at first surgery was 9.8 years, and the average follow-up was 4.3 years. For acquired cholesteatoma, most ears were managed with canal wall up (CWU) approaches, but ultimately 6/15 (40.0%) required canal wall down (CWD) approaches. Postoperatively, 3 (20.0%) ears developed new tympanic membrane retraction pockets, but no recurrent cholesteatoma. Four (26.7%) ears developed recurrent disease, and 3 (20.0%) had residual disease at secondary procedures. Ossiculoplasty was performed in 4 ears. Twelve (70.6%) ears were rehabilitated with hearing aids or FM systems. Conclusions The diagnosis of cholesteatoma in Down syndrome was associated with otorrhea, hearing loss, and CT scan findings of ossicular erosion and mastoid sclerosis. Most cases were managed with CWU surgical approaches. Hearing aid use was common post-operatively.

Cholesteatomas in children have a more aggressive growth pattern compared to adults, which leads to a higher incidence of both residual and recurrent disease. A staged canal wall-up or a canal wall-down tympanomastoidectomy (CWUT and CWDT, respectively) is selected depending on the extent of the disease and condition of the middle ear (ME) cleft and mastoid. Endoscopic ear surgery (EES) has been recently introduced as an adjuvant tool for the treatment of this pathology even in the pediatric population. Objectives To analyze long term outcomes of CWUT and CWDT in the pediatric population, focusing on residual and recurrence rates of cholesteatoma and hearing results. A literature review including cases treated with EES were discussed. Material and methods Pediatric patients treated for cholesteatoma involving both the ME and mastoid with a follow-up (FU) of at least 4 years were retrospectively analyzed in a quaternary referral center for otology and lateral skull base surgery. Patients were grouped according to the surgical technique (CWUT versus CWDT). Rates of residual and recurrent cholesteatoma after each surgical technique were reported and compared. Mean Air-Bone Gap (ABG) of 0.5-1-2-4 KHz was measured and reported before the first surgery and at the last post-operative FU. Results Two-hundred and thirty-six cases fulfilled our inclusion criteria. The mean FU was 100.4 ± 44.2 months (median 89 months). One-hundred and five (44.5%) cases underwent a CWUT, whereas 131 (55.5%) a CWDT. A second stage surgery was performed in 73.5% of CWUT and 58.7% of CWDT. Among the CWUT group, residual cholesteatoma occurred in 22 (21%) ears and recurrence in 24 (22.9%). Patients undergoing CWDT showed lower rates of both residual and recurrent cholesteatoma (7.6% and 2.3%, respectively). ABG improvement was noted for both groups, even though CWUT showed better post-operative hearing results. Conclusions The CWDT technique offers a definite surgical therapy, with minimal residual and recurrence rates and audiological results comparable to the CWUT technique. EES must still prove its added benefit or equivalence to pure microscopic approaches.

Nasopharyngeal cancer (NPC) with mastoid recurrence is extraordinarily rare, and its development is thought to involve the Eustachian tube. We herein report a case of NPC with mastoid recurrence masquerading as acute otomastoiditis with facial paralysis in a 60-year-old man 44 months after concurrent chemoradiotherapy. The diagnosis was confirmed by exploratory tympanomastoidectomy with biopsy and Epstein-Barr-encoding region (EBER) in situ hybridization. Distant liver metastasis was detected simultaneously, and the patient underwent salvage treatment. He died 15 months later. Despite the rarity of mastoid recurrence, clinicians should be vigilant in the differential diagnosis of mastoiditis in patients with NPC after radiotherapy. Tumor biopsy and EBER in situ hybridization can aid in the accurate diagnosis of this uncommon condition.

Objectives To describe the impact of resident involvement in tympanoplasty on operative time and surgical complication rates. Study Design Case series with chart review. Setting Tertiary medical center. Subjects and Methods Current Procedural Terminology codes were used to identify patients in the 2011-2014 public use files of the American College of Surgeons National Surgical Quality Improvement Program who underwent a tympanoplasty or tympanomastoidectomy. Cases were included if the database indicated whether the operating room was staffed with an attending alone or an attending with residents. Categorical and continuous variables were compared with chi-square, Fisher's exact, and Mann-Whitney U tests. Generalized linear models with a log-link and gamma distribution were used to examine the factors affecting operative time. Results Overall, 1045 cases met our study criteria (tympanoplasty, n = 797; tympanomastoidectomy, n = 248). Resident involvement increased mean operative time for tympanoplasties by 46% (107 vs 73 minutes, P < .001) and tympanomastoidectomies by 49% (175 vs 117 minutes, P < .001). While controlling for confounding factors, the variable with the largest impact on operative time was resident involvement. There were no significant differences observed in the rate of surgical complications between attending-alone and attending-resident cases. Conclusion Resident involvement in tympanoplasty and tympanomastoidectomy did not affect the surgical complication rate. Resident involvement increased operative time for tympanoplasties and tympanomastoidectomies; however, the specific reasons for the increase are not explained by the available data.

Objective To evaluate the audiometric outcomes following endoscopic ossicular chain reconstruction (OCR). Study design Retrospective case series. Setting Two tertiary referral centers. Patients Sixty two ears with ossicular discontinuity. Intervention(s) Endoscopic and microscopic OCR in patients with ossicular discontinuity. Main outcome measures Bone and air pure-tone averages (PTA), air-bone gap (ABG), and word recognition scores (WRS). Results Sixty two ears were included for analysis. Patients that underwent ossiculoplasty were subdivided based on prosthesis type (total ossicular replacement prosthesis [TORP] and partial ossicular replacement prosthesis [PORP], primary and staged ossiculoplasties, and surgical approach [microscopic and total endoscopic]). Forty two ears required PORP reconstructions, while 20 ears required TORP reconstructions. The microscope was used to reconstruct the ossicular chain in 31 cases, while an exclusive endoscopic approach was used in the remaining 31 patients. Controlling for the prosthesis, there were no significant postoperative differences in bone PTA, air PTA, and ABG between primary and staged ossiculoplasties, or surgical approach. Conclusions Controlling for the type of prosthesis, there were no significant differences in hearing outcomes with respect to staged ossicular chain reconstruction or whether the endoscope or microscope was used for visualization. Thus, in this series, endoscopic OCR yields similar audiometric outcomes when compared with microscopic OCR.

Objectives To determine if 2Flute (Stryker Corporation, Kalamazoo, MI) otologic burs improve the size, cellular content, and bone healing of autologous cortical bone grafts harvested during canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration. Study Design Institutional review board-approved prospective cohort study. Methods Human autologous cortical bone chips were harvested using various burs (4 and 6 mm diameter; multiflute, and 2Flute [Stryker Corporation]) from patients undergoing CWR tympanomastoidectomy for the treatment of chronic otitis media with cholesteatoma. Bone chip size, cell counts, cellular gene expression, and new bone formation were quantified. Results Bone chips were significantly larger when harvested with 2Flute (Stryker Corporation) bur compared to multiflute burs at both 6 mm diameter (113 ± 14 μm2 vs. 66 ± 8 μm2; P

Objectives Non-echoplanar imaging (Non-EPI) MRI has been recently introduced to improve the detection of small sized cholesteatoma and decrease different artifacts occurring in the echo-planar diffusion weighted image (EPI DWI) technique. It is a time saving procedure in comparison to the delayed post-contrast imaging. We prospectively assessed the diagnostic accuracy of Non-EPI-DW sequences in the detection of middle ear cleft cholesteatoma. Material and methods Forty patients suspected to have cholesteatoma were collected from the ENT outpatient clinic of a tertiary referral center. Twenty patients underwent primary mastoid surgery, ten patients scheduled for revision mastoid surgery, while the remaining patients underwent second look operation after one year of their first surgery. All patients underwent Non-EPI-DW sequences prior to their planned surgery. Diagnosis of cholesteatoma was based on evidence of a hyperintense lesion on diffusion-weighted images that were correlated with the surgical findings and histopathological examination, which was used as the gold standard for diagnostic confirmation. Sensitivity, specificity and predictive values of MRI were estimated. Results Diffusion weighted imaging accurately predicted the presence of cholesteatoma in 88.2% of cases, and it correctly excluded it in 100% of cases. Sensitivity, specificity, positive and negative predictive values were 88.24%, 100%, 100% and 60%, respectively. Non-echo-planar DWI has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. Conclusions Non-echoplanar DWI is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2 mm.

The aim of this review is to describe and evaluate transcanal endoscopic technique for treatment of acquired Cholesteatoma. This article discusses advantages of endoscopic ear surgery in treating Cholesteatoma and how the hidden sites like the facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope thereby reducing residual Cholesteatoma. Additionally, endoscopic techniques allow better access to the tympanic cavity and protympanum, which translates into better understanding of the etiology of ventilation and reduces recurrent disease. The transcanal endoscopic approach allows minimally invasive removal of Cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.

ObjectiveTo correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy.MethodsThis retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans.ResultsPre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05).ConclusionPre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Tetra-amelia is a rare congenital disorder characterized by the absence of limbs. We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery.

Objective To investigate the recidivism rate of cholesteatoma treated via endoscopic ear surgery (EES), either via transcanal endoscopic ear surgery or endoscopic assisted tympanomastoidectomy compared with a microscopic postauricular approach. Study design Retrospective chart review. Setting Academic otology practice. Patients Adult patients (18 years and older) with at least 11 months of surgical follow-up who were treated for cholesteatoma via endoscopic techniques or microscopic postauricular approach. Intervention Use of the endoscope for cholesteatoma dissection. Main outcome measure Residual or recurrent cholesteatoma identified at second look surgery or postoperative diffusion-weighted magnetic resonance imaging. Results Fifty-nine patients treated for cholesteatoma via endoscopic techniques and 35 patients treated via microscopic postauricular approach were analyzed. The endoscopic group required significantly fewer mastoid procedures (28% versus 80%, p-value 0.001). Postoperative changes in median ABG (5 dB versus 3.75 dB, p = 0.9519), median PTA (6.875 dB versus 1.25 dB, p = 0.3864), and median word recognition score (0% versus 0%, p = 0.3302) were not significantly different between the EES and microscopic surgery groups. Median operative times were not significantly different between the two groups (182 min endoscopic versus 174 min microscopic, p-value 0.66). The rate of residual disease (17% EES versus 17% microscopic, p = 0.959) or disease recurrence (18% endoscopic versus 20% microscopic, p = 0.816) were not significantly different between the two groups. Conclusions EES is an effective option for cholesteatoma management with similar rates of recurrent or residual disease as compared with the more traditional microscopic postauricular approach in these samples.

Objectives To evaluate the effects of size of temporal fascia graft on healing of the mastoid cavity in patients undergoing canal wall down (CWD) procedures. Materials and methods The study included 32 patients (ages from 10 to 69 years) who were performed CWD tympanomastoidectomy from 2016 to 2018. Patients were divided into 2 different groups randomly based on size of fascia used in the operations. Group 1 consisted of 19 patients with temporal muscle fascia large enough to extend up to antrum by passing through over the facial ridge. Group 2 consisted of 13 patients with fascia of a size hardly enough to create a middle ear space, which were quite smaller than those the first group. It was also observed that whether or not the type of pathology (cholesteatoma, granulation tissue or both) had an effect to the epithelialization time of the cavity. Results Thirty-two patients met inclusion criteria. Nineteen patients were randomized to study (large fascia) group and 13 patients were to control (small fascia) group. The mean duration for epithelialization of cavities with study group-large grafts was 34.10 days and that was 39.76 days in control group-small grafts. According to type of pathology; in cases with cholesteatoma, with granulation, and cases of coexisting granulation with cholestatoma; the mean epithelialization times were 38.73, 31.33 and 34.42 days, with respectively. Conclusion Placement of larger fascia graft to line the mastoidectomy cavity facilitate rapid epithelialization and healing in patients undergoing CWD tympanomastoidectomy. Further studies with larger groups would be beneficial to confirm this result in the aspect of statistical significance.

Objective To evaluate the reasons for persistent draining ear and cholesteatoma recidivism following canal wall down (CWD) tympanomastoidectomy by studying the sensitivity of high-resolution computed tomography (HRCT) scanning in different potential etiologies, corroborating through appropriate surgical intervention, and thereby, to suggest proper preventive measures. Methods In this observational study, 32 chronic, refractory draining ears were subjected to revision surgery following a radical or a modified radical mastoidectomy. Besides disease (cholesteatoma/granulations) eradication, pitfalls of the primary surgeries were addressed. Data were interpreted for studying the epidemiologic profile, the clinical presentation at recurrence, the type of primary surgery, the sites of recidivism, the probable causes, and the best possible management at revision. Results Of the 32 patients/ears, 23 had residual/recurrent cholesteatoma. Major reasons were inadequate disease clearance, contracted/inadequate conchomeatoplasty, no cavity obliteration, and inappropriate bone work. HRCT predicted persistent bridge and lateral semicircular canal dehiscence with 100%, and ossicular integrity and bony overhang with >80% sensitivity. Sinus tympani and oval window niche were the commonest sites of recurrence. At revision, radical/modified radical mastoidectomies were associated with cavity obliteration and appropriate revision of conchomeatoplasty in 28 patients. Conclusion Recurrence of cholesteatoma/granulations is an important cause for chronic drainage from post-CWD cavities. Revision surgery explores the surgical pitfalls, and ensures clearance of disease from hidden areas, adequate bone work, and optimum conchomeatoplasty following cavity obliteration to provide a safe, dry ear with hearing improvement whenever feasible.