Search

Introduction In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. Methods A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18–55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. Results There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. Conclusions Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke.

INTRODUCTION In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. METHODS A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. RESULTS There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. CONCLUSIONS Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Acquired external auditory canal (EAC) stenosis is an uncommon condition with an incidence of 0.6 in 100,000 population. Road traffic accidents and otology surgeries are the frequently reported causes for it to occur. The high rate of restenosis makes this condition difficult to manage. A 50 year old lady presented with history of accidental instillation of acid in her left ear at 6 months of age by the care giver. The patient developed stenosis of left EAC with hearing loss. Examination revealed pin point stenosis of left EAC. Puretone audiogram revealed a moderately severe conductive hearing loss. Computed tomogram showed soft tissue lesion obliterating the entire EAC and extending into the middle ear and antrum. Intra operatively only the cartilaginous EAC was stenosed. Surgical excision of the fibrotic scar with a tympanomastoidectomy and wide meatoplasty was done. Regular post operative aural toileting, packing with merocele strips and application of topical antibiotic -steroid preparations was done. 6 months post-surgery a patent EAC and healed tympanic membrane was achieved. In this report, we present a rare case of lateral EAC stenosis secondary to corrosive acid injury, highlighting the surgical steps, post operative care and surgical outcomes. A limited review of literature is also presented. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of a machine learning model and the effects of major prognostic factors on hearing outcomes following intact canal wall (ICW) mastoidectomy with tympanoplasty. Study Design: Retrospective cross‐sectional study. Setting: Tertiary hospital. Methods: A total of 484 patients with chronic otitis media who underwent ICW tympanomastoidectomy between January 2007 and December 2020 were included in this study. Successful hearing outcomes were defined by a postoperative air‐bone gap (ABG) of ≤20 dB and preoperative air conduction (AC)‐postoperative AC value of ≥15 dB according to the Korean Otological Society guidelines for outcome reporting after chronic otitis media surgery. The light gradient boosting machine (LightGBM) and multilayer perceptron (MLP) models were tested as artificial intelligence models and compared using logistic regression. The main outcome assessed was the successful hearing outcome after surgery, measured using the area under the receiver operating characteristic curve (AUROC). Results: In the analysis using the postoperative ABG criterion, the LightGBM exhibited a significantly higher AUROC compared to those of the baseline model (mean, 0.811). According to the difference between preoperative and postoperative AC, the MLP showed a significantly higher AUROC than those of the baseline model (mean, 0.795). Conclusion: This study analyzed multiple factors that could affect the hearing outcome using different artificial intelligence models and found that preoperative hearing status was the most important factor. Our findings provide additional information regarding postoperative hearing for clinicians. [ABSTRACT FROM AUTHOR]

ObjectivesThe primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques.MethodsA retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1–2.2) vs. 2.0 years (IQR 1.2–3.1) (p = 0.013).Intervention(s)All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears (n = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma.Main outcome measure(s)The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing.ResultsIn this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p

Objectives: To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. Methods: This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. Results: Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p<0.05. Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001). Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making. [ABSTRACT FROM AUTHOR]

To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients. This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures. Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009). Our study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes. [ABSTRACT FROM AUTHOR]

Introduction:Hearing results after chronic ear surgery encompass recurrence, localization and extent of cholesteatoma, type of surgery, ossiculoplasty methods, but rarely interpret intraoperative findings. This study aimed to analyze the impact of intraoperative findings in revision tympanomastoidectomy in predicting postoperative hearing.Materials and Methods:This was a retrospective non-randomized cohort of 101 patients treated for recurrent chronic otitis media by tympanomastoidectomy. The patients’ demographics, localizations of disease recurrence and perioperative hearing results were analyzed.Results:Logistic regression showed that presence of tympanic perforation (p=0.036), ossicular chain damage (p=0.006), were negatively associated with improved hearing postoperatively. Attic cholesteatoma was associated with better postoperative hearing (p=0.045). Presence of tympanic perforation (p=0.050), alongside perifacial localization of imflammation (p=0.021) and ossicle destruction (p=0.013) were associated with worse postoperative hearing results. Multivariate analysis confirmed that tympanic perforation (p=0.040, F=4.401), and ossicular chain involvement (p=0.025, F=5.249), were consistent negative predictors of hearing improvement, while postoperative deterioration of hearing was associated with tympanic perforation (p=0.038, F=4.465) and facial nerve dehiscence (p=0.045, F=4.160).Conclusions:Comparison of postoperative revision tympanomastoidectomy hearing outcomes revealed significant positive reductions in air-bone gap values, primarily at low and mid frequencies. Postoperative hearing results at high frequencies are not affected by revision surgery.

Purpose: We aimed to present the management of the patients with necrotizing otitis externa (NOE) and its comorbidities in early and long-term follow-up. Methods: Between 2011 and 2022, 30 patients with the diagnose of NEO, who had cortical bone erosion or trabecular demineralization in temporal bone computed tomography and administered at least 6-week antimicrobial therapy were included in the study. Clinical, laboratory and imaging findings of patients, and comorbidities during follow-up were analysed. NOE extending further from the petro-occipital fissure on magnetic resonance imaging was accepted as medial skull base (MSB) involvement. Results: 30 patients, (8 women, 22 men, mean age 66.2 ± 1.7), with NOE were followed 36.4 ± 29.6 months. The mortality rate was 23.33% and the mean survival time was 12.37 ± 11.35 months. Repeated cultures reveal a new or second pathogen in 5 patients (20%). Severe and profound sensorineural hearing loss (SNHL) were observed in 4 and 12 patients, respectively. Labyrinthitis ossificans emerged in 3 of 6 surviving patients with profound SNHL during follow-up. Chronic disease anemia (CDA) (66.66%), cerebrovascular disease (CVD) (43.33%), chronic renal failure (CRF) (30%), and retinopathy (26.66%) were the most frequent comorbidities in patients with NOE. Cranial nerve paralysis (CNP) (P < 0.001), SNHL (P < 0.04), CDA (P < 0.005), and mortality (P < 0.022) were significantly associated with the presence of MSB involvement. Conclusions: NOE is a disease that requires long-term follow-up, causes severe morbidity, and has a high mortality rate. MSB involvement is associated with CNP, SNHL and labyrinthitis ossificans. Moreover, CDA, CVD, CRF and retinopathy are the most common comorbitidies needed to be managed. [ABSTRACT FROM AUTHOR]

Introduction: Hearing results after chronic ear surgery encompass recurrence, localization and extent of cholesteatoma, type of surgery, ossiculoplasty methods, but rarely interpret intraoperative findings. This study aimed to analyze the impact of intraoperative findings in revision tympanomastoidectomy in predicting postoperative hearing. Materials and Methods: This was a retrospective non-randomized cohort of 101 patients treated for recurrent chronic otitis media by tympanomastoidectomy. The patients' demographics, localizations of disease recurrence and perioperative hearing results were analyzed. Results: Logistic regression showed that presence of tympanic perforation (p=0.036), ossicular chain damage (p=0.006), were negatively associated with improved hearing postoperatively. Attic cholesteatoma was associated with better postoperative hearing (p=0.045). Presence of tympanic perforation (p=0.050), alongside perifacial localization of imflammation (p=0.021) and ossicle destruction (p=0.013) were associated with worse postoperative hearing results. Multivariate analysis confirmed that tympanic perforation (p=0.040, F=4.401), and ossicular chain involvement (p=0.025, F=5.249), were consistent negative predictors of hearing improvement, while postoperative deterioration of hearing was associated with tympanic perforation (p=0.038, F=4.465) and facial nerve dehiscence (p=0.045, F=4.160). Conclusions: Comparison of postoperative revision tympanomastoidectomy hearing outcomes revealed significant positive reductions in air-bone gap values, primarily at low and mid frequencies. Postoperative hearing results at high frequencies are not affected by revision surgery. [ABSTRACT FROM AUTHOR]

Objectives: Access to and utilization of perioperative healthcare may influence outcomes in patients with chronic suppurative otitis media (CSOM); however, the influencing factors are poorly understood. The objective of this study was to assess the association of sociodemographic factors with perioperative health care utilization for pediatric CSOM patients. Methods: We conducted a review on pediatric CSOM patients (≤18 years old) who underwent tympanoplasty with/without mastoidectomy between 2010 and 2020. Sociodemographic data and clinical were collected on all participants. Univariate and multivariate logistic regression analysis was conducted to assess the association between these factors and perioperative care utilization. Results: 427 patients were included in the study. The primary factor associated with health care utilization was insurance status. Rural children were more likely to have Medicaid insurance (p = 0.048). For tympanoplasty patients, Medicaid patients have 1.66 higher odds of pre‐operative no‐shows (p = 0.01), 1.31 higher odds of post‐operative no‐shows (p = 0.02), and 59% lower odds of having a postoperative audiogram (p = 0.01), and 2.64 higher odds of being from a rural community (p = 0.02). For patients undergoing mastoidectomy, Medicaid patients have 1.25 higher odds of postoperative no‐shows (p = 0.01), 39% lower odds of having a revision procedure for ossicular reconstruction (p = 0.045). Appalachian rural mastoidectomy patients had 3.62 higher odds of having cholesteatoma (p = 0.05). Conclusion: Pediatric patients with CSOM who have Medicaid insurance, especially those who reside in rural regions, are at risk for lower perioperative hearing health care utilization. As these findings may impact care delivery and clinical outcomes, efforts should be focused on promoting utilization among these populations. Level of Evidence: 4 Laryngoscope, 133:700–705, 2023 [ABSTRACT FROM AUTHOR]

Purpose: The relatively new technique of trans-canal endoscopic ear surgery (TEES) when compared to microsurgery for ossiculoplasty has advantages of better visualization and no external incision but also has the disadvantage of being a one-handed procedure. Our study aimed to compare audiometric outcomes following ossiculoplasty performed via TESS with results of microsurgery. Materials and methods: Data from a prospective audit of 157 consecutive patients who underwent ossiculoplasty by a single otologist from 2009 to 2018 was analyzed. TEES was introduced in the department in 2014; therefore, all patients before this period underwent microsurgery. Patients were classified by surgical approach, TEES, or microsurgery. Audiological outcomes were recorded at 3 and 12 months postoperatively and compared to pre-operative levels. Other variables included were the condition of stapes and reconstruction material used. Results: Of the 157 cases, 50 were TEES and 107 were microsurgery (81 microscope only and 27 combined with endoscope). There was statistically significant improvement (p < 0.001) in AC (43.4 dB pre-operatively, 36.2 dB postoperatively), BC (20.3 dB pre-operatively, 17.6 dB postoperatively), and ABG (21.8 dB pre-operatively, 16.7 dB postoperatively) in the total cohort. Both groups achieved an ABG better than 20 dB; 72% in TEES, 73% in the microscopic group, and there was no significant difference. There was no change in hearing at 12 months when compared to 3 months. No statistically significant difference was noted based on stapes condition, type of material used for ossiculoplasty, or tympanic membrane graft. Conclusion: TEES is safe and as effective as microsurgery in ossiculoplasty with possibly much less pain and morbidity. Level of evidence: 3. [ABSTRACT FROM AUTHOR]

Introduction: In all otologic surgeries, the facial nerve can be considered the most important structure that must be protected. The surgical damage risk of the facial nerve will be increased in the presence of facial canal dehiscence (FCD). Aim: In this study, we aimed to evaluate FCD and its associated situations in patients with chronic otitis media undergoing mastoidectomy. Materials and methods: 850 patients who performed ear surgery were reviewed. Patients who did not perform mastoidectomy were excluded. In patients, the ratios, locatation of FCD, and association of facial canal dehiscence with cholesteatoma were researched. Association between FCD and closed-cavity tympanomastoidectomy, open-cavity tympanomastoidectomy, and radical mastoidectomy procedures, and also an association between FCD and primary or revision surgery were evaluated. Results: Facial canal dehiscence was found in 8.4% of patients. The relationship between dehiscence and cholesteatoma was found significant (P<0.001). In the comparison of radical mastoidectomy and closed-cavity tympanomastoidectomy, dehiscence was higher in the radical mastoidectomy group (P<0.03). In revision cases, dehiscence was seen more frequently (P<0.003). FCD incidence was higher in adult patients than in pediatric patients (P<0.001). 20 of 468 patients who were operated on for cholesteatoma had congenital cholesteatoma. Conclusion: Facial canal dehiscence can be seen especially in cases with cholesteatoma and when performing radical mastoidectomy and revision surgeries. Therefore, a detailed evaluation of the status of facial nerve and determination of situations in which occurrence of FCD is more likely both preoperatively and intraoperatively will minimalize potential complications. [ABSTRACT FROM AUTHOR]

To assess quality of life (QOL) outcomes after canal wall up (CWU) and canal wall down (CWD) tympanomastoidectomy in the pediatric population.A retrospective review tabulated pediatric patients undergoing CWU and CWD tympanomastoidectomy for cholesteatoma by 2 senior surgeons at a single tertiary academic referral center between March 2017 and March 2023. Chronic Ear Survey (CES) and cosmetic survey outcomes were collected post-operatively.A total of 77 ears in 75 patients were identified, with 35 undergoing CWU and 42 undergoing CWD as the most recent (index) otologic surgery. Seventeen patients (23%) participated in the survey. Of this cohort, the mean age was 14.6 years, 12 (71%) were male, and 10 (59%) had CWD as the most recent otologic surgery. The mean time from index surgery to survey completion was 3.4 years (range, 0.1-6.7 years). Regarding QOL outcomes, there were no statistically significant differences in total CES score, CES subscores, and cosmetic survey scores between groups when categorizing by gender or index surgery. Total CES, symptom subscale, medical resource subscale, and cosmetic survey scores showed a tendency to decrease with an increasing number of surgeries (R = −.18, −.28, −.53, and −.56, respectively). Pediatric total CES scores appeared comparable to those reported in the published adult literature.It does not appear that there are worse QOL outcomes for pediatric patients who undergo CWD tympanomastoidectomy compared to those who undergo CWU tympanomastoidectomy. There appears to be no difference in QOL outcomes between pediatric and adult patients undergoing tympanomastoidectomy. [ABSTRACT FROM AUTHOR]

Aim: For a correct and adequate chronic otitis media surgery, it is necessary to correctly define the anatomical structures and to know their possible variations, otherwise, an increase in the complication rate is inevitable. This study aims to present the anatomical variations detected both in preoperative computerized tomography scanning and during operation, and complication rates encountered in 308 patients who underwent tympanomastoidectomy due to chronic otitis media in the light of current literature knowledge. Materials and Methods: In this retrospective study, the files of 308 patients who underwent tympanomastoidectomy due to chronic otitis media in a tertiary clinic between September 2011 and July 2019 were scanned for encountered anatomical variations detected both in preoperative computerized tomography scanning and during operation and complications. Results: There was Körner septum in 12 (3.8%) cases, dehiscence in the facial nerve tympanic segment in 12 (3.8%) cases, and lateral semicircular canal dehiscence (LSCD) in 4 (1.3%) cases. In 4 (1.3%) cases, it was observed that the dura was located downward and in 6 (1.9%) cases, the sigmoid vein was located anterosuperiorly. Conclusion: Always being careful in terms of anatomical variations and possible complications during the operation will increase the success of the surgery. Knowing the anatomical variations and complications related to the temporal region is of great importance for clinicians dealing with ear surgery.

Objective: To report health utilization patterns and outcomes of medical and surgical management in patients with chronic suppurative otitis media (CSOM). Study Design: Retrospective cohort. Setting: Academic otology clinic. Methods: 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 by International Classification of Diseases code, had at least 1 episode of active CSOM (defined as perforation with otorrhea), and had a documented history of chronic ear infections. The mean age was 49.5 ± 1.5 years, 53% were female, and mean follow-up time was 3.5 ± 0.3 years. Results: Patients 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 (P =.73). At the most recent visit, the prevalence of all patients with CSOM displaying moderate or worse sensorineural hearing loss (SNHL) was 41%. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Purpose: To characterize postoperative pain after tympanoplasty and tympanomastoidectomy and correlate between pain severity and various technical aspects of the surgery. Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

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]

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]

Aim: To present our ten-year experience in mastoid obliteration using the inferiorly based postauricular periosteal-pericranial flap in canal wall down (CWD) tympanomastoidectomy, and review its efficacy in producing a dry, small, low-maintenance mastoid cavity. Materials and methods: A retrospective study of sixty-four consecutive procedures of CWD tympanomastoidectomy was conducted over the period from 2007 to 2017 for the treatment of active chronic otitis media, with or without cholesteatoma. The main outcome measure was the successful control of suppuration to create a dry, self-cleansing mastoid cavity. Results: Fifty-three ears (82.8 %) had a small, dry, healthy, and self-cleaning mastoid cavity. Four ears (6.3%) had intermittent otorrhea easily controlled by topical and systemic antibiotic treatment and aural toileting. Seven patients (10.9 %) had persistent otorrhea of which three had meatal stenosis, two had granulation tissue and two had recurrence of cholesteatoma. Outcomes remained stable over progressively more extended follow-up periods (up to 132 months). Conclusion: The use of postauricular periosteal-pericranial flap for mastoid obliteration in CWD tympanomastoidectomy is a very effective technique that results in a dry, small, self-cleaning mastoid cavity in 89.1 % of patients with active chronic otitis media with or without cholesteatoma. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to determine whether obliteration of the epitympanic area and mastoid cavity during canal wall up (CWU) cholesteatoma surgery reduces the rate of recurrent and residual cholesteatoma compared to not obliterating the same area. The secondary objective was to compare postoperative hearing outcomes between both techniques., Methods: A retrospective cohort study was conducted in a tertiary referral center. One-hundred-fourty-three ears were included of patients (≥18y) who underwent a CWU tympanomastoidectomy for cholesteatoma with or without bony obliteration between January 2015 and March 2020 in the University Medical Center Utrecht. The median follow-up was respectively 1.4 (IQR 1.1-2.2) vs. 2.0 years (IQR 1.2-3.1) ( p  = 0.013)., Interventions: All patients underwent CWU tympanomastoidectomy for cholesteatoma. For 73 ears bone dust, Bonalive® or a combination was used for obliteration of the mastoid and epitympanic area, the rest of the ears ( n  = 70) were not obliterated. In accordance with the Dutch protocol, included patients are planned to undergo an MRI scan with diffusion-weighted imaging (DWI) one, three and five years after surgery to detect recurrent or residual cholesteatoma., Main Outcome Measures: The primary outcome measure was recurrent and residual cholesteatoma as evaluated by MRI-DWI and/or micro-otoscopy and confirmed by micro-otoscopy and/or revision surgery. The secondary outcome measure was the postoperative hearing., Results: In this cohort, the group treated with canal wall up tympanomastoidectomy with subsequent bony obliteration (73 ears, 51.0%) had significantly lower recurrent (4.1%) and residual (6.8%) cholesteatoma rates than the group without obliteration (70 ears, 25.7% and 20.0%, respectively; p  < 0.001). There was no significant difference between both groups in postoperative bone conduction thresholds (mean difference 2.7 dB, p  = 0.221) as well as the mean air-bone gap closure 6 weeks after surgery (2.3 dB in the non-obliteration and 1.5 dB in the obliteration group, p  = 0.903)., Conclusions: Based on our results, a canal wall up tympanomastoidectomy with bony obliteration is the treatment of choice, since the recurrent and residual disease rate is lower compared to the group without obliteration. The bony obliteration technique does not seem to affect the perceptive or conductive hearing results, as these are similar between both groups., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Erfurt, Westerhout, Straatman, Smit, Stokroos and Thomeer.)

Aims: To evaluate a group of patients undergoing surgery for chronic otitis media with reference to the prognostic value of middle ear risk index and other factors in predicting the anatomical and functional outcome of tympanomastoidectomy with tympanoplasty. Subjects: The study comprised of 90 patients suffering from chronic otitis media with or without cholesteatoma. Patients attending the Otorhinolaryngology out patients department were considered for this study. Methods: The patients underwent tympanomastoidectomy with tympanoplasty in which mastoidectomy performed was of either canal wall up or canal wall down technique. In cholesteatoma surgery, whenever possible a canal wall up procedure was performed. Myringoplasty was done using autologous temporalis fascia graft by underlay technique. Middle ear risk index [MERI] and other factors were evaluated for their outcome predictive role in patients undergoing tympanomastoidectomy with tympanoplasty. Results: Outcomes were evaluated in terms of tympanic membrane graft uptake and post operative mean audiological gain. The Middle ear risk index was also found to be significant predictor of the outcome of surgery. The patients with mild MERI scores had significantly better prognosis than the patients with sever MERI scores. Conclusion: The Anatomical and Functional outcome of tympanomastoidectomy with tympanoplasty is diversely affected by the pathological and technical factors associated with disease and its management. A better understanding of these factors is helpful for better prognostication of the factors affecting the disease and in planning the surgical procedure. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media (COM) has been broadly classified into mucosal and squamous subtypes. COM types are associated with erosion of the ossicular chain. The aim of the present study was to correlate the type of COM, the site of perforation/retraction, and the type of disease pathology with the pattern and degree of ossicular chain necrosis. Materials and Methods: A prospective cross-sectional study was performed in 76 cases of COM, who were subjected to tympanomastoidectomy. Pre-operative findings were compared with per-operative ossicular chain status and pathology. Results: Incus was found to be the most vulnerable ossicle for erosion, followed by malleus and suprastructure of stapes. The pattern of multiple ossicle involvement was more common. Ossicular chain erosion was more common in squamous COM than mucosal COM (X2=66.25; P=0.0001) and in the presence of cholesteatoma and granulations. Ossicular necrosis was most common in squamous disease with cholesteatoma, followed by squamous disease with granulations, mucosal disease with granulations, and inactive mucosal disease in that order. Conclusion: The degree of ossicular necrosis has a positive correlation with the type of disease pathology, being higher in squamous disease than in mucosal disease. The pattern of ossicular necrosis varies with the site of origin of the disease and the pattern of spread of cholesteatoma, being variable for pars tensa and pars flaccida squamous disease.

Objectives. To determine whether a separate, staged procedure for ossicular chain reconstruction (OCR) results in significantly different hearing results when compared to OCR performed concurrent with tympanomastoidectomy for cholesteatoma. Materials and method. We only included patients undergoing OCR for cholesteatoma within a 5-year period (January 2013 – December 2017). The interventions were OCR concurrent with tympanomastoidectomy (Group I) or OCR staged following tympanomastoidectomy for cholesteatoma (Group II). The staged procedure was performed within 16 months. The main outcome measures were mean postoperative air-bone gap (ABG) – the mean value, the proportion of patients achieving the ABG closure <20 dB and <30 dB, respectively – and the way it depended on the type of mastoid cavity created (open or closed) and on the status of the stapes superstructure (TORP versus PORP). Results. Seventy- seven patients were included in the study, 34 patients being included in Group I and 43 in Group II. The overall hearing results did not differ significantly in the two groups. When considering the status of the stapes and mastoid cavity, concurrent OCR resulted in an improved mean postoperative ABG in a closed mastoid cavity with an intact stapes superstructure (P=0.043). Furthermore, a greater proportion of patients who had concurrent OCR within this group achieved ABG <20 dB and ABG <30 dB, although this difference did not reach a statistical significance. By contrast, staged OCR resulted in improved mean postoperative ABG in open mastoid cavities with an absent stapes superstructure (P=0.046). A greater proportion also achieved ABG <20 dB and ABG <30 dB, but it was not statistically significant. Conclusions. Staged OCR is preferable in patients with more severe disease, whereas those with a less severe disease may benefit from a concurrent OCR. [ABSTRACT FROM AUTHOR]

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<0,001). Clinical meaning of using musculus temporalis fascia profunda graft is better than composite graft in terms of hearing and tympanic membrane elasticity. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To retrospectively evaluate the data of patients with chronic suppurative otitis media (CSOM) who were operated and who also had routine preoperative temporal bone computed tomography (CT) inorder to determine the role of preoperative CT in CSOM surgery. METHODS: Preoperative CT results and intraoperative data of 42 patients with chronic suppurative otitis media were retrospectively evaluated. RESULTS: Cholesteatoma was determined in 23 cases (54.76%) during operation and in 21 of those cases cholesteatoma presence was reported in preoperative CT evaluations. CT evaluation had a 91.30% (confidence interval (CI): 71.96%-98.93%) sensitivity and 78.95% (CI: 54.43%-93.95%) specificity regarding determination of cholesteatoma. Intraoperative ossicular chain destruction was reported in 32 (76.19%) patients and in 27 of them, CT reported ossicular chain destruction. CT evaluation had a 84.38% (CI: 67.21%-98.93%) sensitivity and 80% (CI: 44.39%-97.48%) specificity regarding determination of ossicular chain destruction. DISCUSSION AND CONCLUSION: We believe that, preoperative CT provides important data in surgical management of CSOM and for that reason all patients should be evaluated with CT in preoperative period.

Objective: To evaluate the efficacy of tympanomastoidectomy versus parenteral antibiotic therapy for otorrhea as a result of chronic suppurative otitis media (CSOM) without cholesteatoma in the pediatric population., Methods: A retrospective review of 221 patients treated for otorrhea at a tertiary academic pediatric hospital was performed to evaluate the impact of tympanomastoidectomy versus parenteral antibiotic therapy on resolution of otorrhea. Inclusion criteria were age 0-18 years, prior treatment with otic and/or oral antibiotic, prior history of tympanostomy tube placement for recurrent otitis media, history of otorrhea, treatment with tympanomastoidectomy or parenteral antibiotic therapy, and follow-up of at least 1 month after intervention. Time to resolution was compared between the two modalities adjusting for age, bilateral ear disease status, and comorbidities using a Cox proportional hazard model., Results: Eighty-three ears from 58 children met the inclusion criteria. Ears that initially underwent tympanomastoidectomy had a significantly shorter time to resolution of symptoms (median time to resolution) 9 months (95 % confidence interval CI: 6.2-14.8) vs. 48.5 months (95 % lower CI 9.4, p = 0.006). On multivariate analysis, however, only bilateral ear disease status was independently associated with time to resolution of symptoms (hazard ratio 0.4, 95 % CI 0.2-0.9, p = 0.03). There was no statistically significant difference in the rate of treatment-related complications when comparing tympanomastoidectomy to parenteral antibiotic therapy (p = 0.37)., Conclusion: When adjusting for age, bilateral ear disease status, and comorbidities, there does not appear to be a significant difference in time to resolution of symptoms when comparing parenteral antibiotic therapy to tympanomastoidectomy. An informed discussion regarding risks and benefits of each approach should be employed when deciding on the next step in management for patients with CSOM who have failed more conservative therapies., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The main surgical techniques for the treatment of chronic otitis media so far, all have their characteristic advantages and disadvantages. Otolaryngologists have been trying to find an ideal surgical method for chronic otitis media. Objective: To study and evaluate the outcome of partial canal wall preserved tympanomastoidectomy (PCM) for the treatment of chronic otitis media. Methods: Thirty-nine patients were randomly divided into two groups. Twenty patients underwent PCM and 19 underwent canal wall down tympanomastoidectomy (CWD). All patients had a follow-up period of 5 years. Results: The mean time of healing was 6 weeks in the PCM group and 8 weeks in the CWD group. The cavities in the PCM group were normal or slightly larger than the normal external auditory canal. The patients required cavity cleaning less than once per year in the PCM group and 3–4 times per year in the CWD group. One patient in the PCM group developed a recurrent cholesteatoma located in the attic. Conclusion: The PCM technique showed a low-recurrence rate and good hearing outcomes. Patients had normal or slightly enlarged postoperative external auditory canal. Therefore, PCM is a useful technique for chronic otitis media. [ABSTRACT FROM AUTHOR]

Abstract Introduction We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss. Case summary A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically. Discussion Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure. [ABSTRACT FROM AUTHOR]

Abstract Introduction The objectives of mastoidectomy in cholesteatoma are a disease-free and dry ear, the prevention of recurrent disease, and the maintenance of hearing or the possibility to reconstruct an affected hearing mechanism. Canal wall down mastoidectomy has been traditionally used to achieve those goals with greater or lesser degrees of success. However, canal wall down is an aggressive approach, as it involves creating an open cavity and changing the anatomy and physiology of the middle ear and mastoid. A canal wall up technique eliminates the need to destroy the middle ear and mastoid, but is associated with a higher rate of residual cholesteatoma. The obliteration technics arise as an effort to avoid the disadvantages of both techniques. Objectives Evaluate the effectiveness of the mastoid obliteration with autologous bone in mastoidectomy surgery with canal wall down for chronic otitis, with or without cholesteatoma. Data Synthesis We analyzed nine studies of case series comprehending similar surgery techniques on 1017 total cases of operated ears in both adults and children, with at least 12 months follow-up. Conclusion Mastoid Obliteration with autologous bone has been utilized for many years to present date, and it seems to be safe, low-cost, with low recurrence rates - similar to traditional canal wall down procedures and with greater water resistance and quality of life improvements.

Background: Although CT has been used widely, the role of preoperative CT findings including other factors in tympanoplasty has not been elucidated comprehensively. Aims/objectives: To evaluate relationship of CT findings with other factors and audiological results in type 1 tympanoplasty. Material and methods: A cohort of consecutive 175 patients with type 1 tympanoplasty was enrolled. Addition of mastoidectomy was based on the presence of soft tissue in antrum on CT. Postoperative air-bone gap (ABG) and reperforation rate were analyzed. Results: Positive soft tissue in antrum on CT was found in 52 (29.7%) patients and showed larger preoperative ABG than the negative group. Successful ABG closure (≤20 dB) was obtained in 97% when preoperative ABG ≤20 dB, but it decreased as the preoperative ABG increased (83% with preoperative ABG of 21-30 dB, and 0% with preoperative ABG >30 dB). Postoperative reperforation rate was positively related to the preoperative ABG, but not the presence of soft tissue in the antrum, the size, or locations of preoperative perforations. Conclusions and significance: Our findings showed that temporal bone CT was helpful in determining addition of mastoidectomy and the presence of soft tissue in the antrum was associated with large ABG. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media (COM) has been broadly classified into mucosal and squamous subtypes. COM types are associated with erosion of the ossicular chain. The aim of the present study was to correlate the type of COM, the site of perforation/retraction, and the type of disease pathology with the pattern and degree of ossicular chain necrosis. Materials and Methods: A prospective cross-sectional study was performed in 76 cases of COM, who were subjected to tympanomastoidectomy. Pre-operative findings were compared with per-operative ossicular chain status and pathology. Results: Incus was found to be the most vulnerable ossicle for erosion, followed by malleus and suprastructure of stapes. The pattern of multiple ossicle involvement was more common. Ossicular chain erosion was more common in squamous COM than mucosal COM (X2=66.25; P=0.0001) and in the presence of cholesteatoma and granulations. Ossicular necrosis was most common in squamous disease with cholesteatoma, followed by squamous disease with granulations, mucosal disease with granulations, and inactive mucosal disease in that order. Conclusion: The degree of ossicular necrosis has a positive correlation with the type of disease pathology, being higher in squamous disease than in mucosal disease. The pattern of ossicular necrosis varies with the site of origin of the disease and the pattern of spread of cholesteatoma, being variable for pars tensa and pars flaccida squamous disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives The postoperative wound infection rate for canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma has been reported to be 3.6%. Postoperative administration of 24-48 hours of intravenous antibiotics has been recommended. We aim to determine the infection rate of CWR with postoperative outpatient oral antibiotics. Study Design Institutional review board-approved retrospective case review. Setting Tertiary referral center. Patients: Retrospective review of consecutive patients who underwent CWR tympanomastoidectomy with mastoid obliteration at a single institution from 2014 to 2016. Main Outcome Measure: Patient characteristics (age, sex) were calculated. Rate of postoperative complications and infections within 1 month of surgery were calculated. Comparison to previous published infection rates with postoperative intravenous antibiotics. Results 51 patients underwent CWR followed by outpatient oral antibiotics with a mean age of 25.9 years (16 patients were less than 10 years old). There were no postoperative wound infections. Outpatient antibiotics showed non-inferiority to IV antibiotic historic controls (0% vs. 3.6%; 95% confidence interval [CI], 0-6.09%; p = 0.03). One patient had small postoperative wound dehiscence with CSF leak that was managed conservatively. One patient developed Clostridium difficile colitis on postoperative day 2. Conclusions The infection rate after CWR tympanomastoidectomy with use of outpatient antibiotics is low and is non-inferior to a historic cohort treated with inpatient intravenous antibiotics. A larger randomized controlled trial is warranted. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To highlight the phenomenon of cholesteatoma arising from the vascular strip following tympanoplasty and tympanomastoidectomy.Study Design: Multi-institutional retrospective chart review.Methods: Consecutive adult and pediatric patients evaluated between 2000 and 2015 with acquired cholesteatoma arising from the skin of a prior vascular strip were identified. Patients with evidence of residual or recurrent cholesteatoma elsewhere in the middle ear, mastoid, or ear canal were excluded.Results: Seventeen cases (71% female, 53% right-sided) were identified, and the mean age at presentation was 39.2 years. Patients presented on average 12.9 years following prior otologic surgery, which was most commonly tympanoplasty without mastoidectomy (59%). However, younger patients presented with symptoms sooner following prior surgery (r = 0.61, r2 = 0.37, P = 0.0095). The most common presenting symptom was otorrhea (76%). All patients were found to have mastoid cholesteatoma with bony erosion, and three patients exhibited additional tegmen or posterior fossa bone defects. The middle ear was not involved with cholesteatoma in any case. A canal wall down procedure was performed due to extensive bony canal erosion in 29% of cases.Conclusion: The vascular strip is an uncommon source of iatrogenic cholesteatoma that can present years following an otherwise uncomplicated otologic surgery. The findings presented herein highlight the importance of careful vascular strip orientation at the conclusion of otologic surgery.Level Of Evidence: 4. Laryngoscope, 127:698-701, 2017. [ABSTRACT FROM AUTHOR]