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Objective: To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia. Study design: Cross‐sectional population‐based study using data from the National Hospital Morbidity Database. Methods: Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12‐month periods of 2007–2008 and 2017–2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person‐years were compared between study periods. Results: Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2–9.0) and 8.1 per 100,000 (95% CI: 7.7–8.5) for 2017–2018 and 2007–2008, respectively. Population aged 10–19 years had the highest age‐specific incidence rate at 12.5 per 100,000 (95% CI: 11.3–13.9) for 2017–2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41–1.86], P <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61–0.78], P <.001]). Conclusions: The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

This novel "Chopstick" drilling technique overcomes the difficulty of drilling with simultaneous suction and irrigation, despite one hand holding the endoscope. The popularity of endoscopic ear surgery is increasing, with reported outcomes comparable to conventional microscopic ear surgery.[[1]] Advantages of endoscopic surgery may include increased visualisation of the recesses of the middle ear such as the sinus tympani,[3] and if the procedure can be done entirely endoscopically, no skin incision is required.[4] However, endoscopic ear surgery has its limitations, one of which is that one hand is occupied holding the endoscope. Self-irrigating piezo-surgery systems exist as an alternative to drilling; however, these still require the surgeon to hold a separate suction (or at least stop to suction at intervals), are currently uncommon, expensive and remove bone at a far slower rate. [Extracted from the article]

Background: Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. Methods: A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. Results: MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. Conclusion: The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs. [ABSTRACT FROM AUTHOR]

The oval window region has recently been identified as a potential route for drug diffusion into the inner ear. Locally applied gadolinium and trimethylphenylammonium (TMPA) have been shown to directly diffuse into the vestibule through the oval window region. Given the potential importance of the oval window region in the diffusion of substances into the inner ear, this work aimed to use micro-CT to obtain a data set of anatomical characteristics of the annular ligament of the stapes in the human temporal bone, a region thus far poorly studied. Twenty-one temporal bones were micro-dissected to preserve the otic capsule and allow perfusion of fixative stains into the inner ear. The specimens were scanned with micro-CT methods to provide 3D reconstructions and measurement. The 3D reconstructions were able to demonstrate an undisturbed stapes footplate and annular ligament from which measurements could be taken. This study found a wide variance in the volumes and thicknesses of the stapedial ligaments. There was a positive correlation between the size of the stapes footplate and the annular ligament. [ABSTRACT FROM AUTHOR]

Background: Eustachian tube dysfunction (ETD) is a common clinical condition encountered by otolaryngologists. The severity and duration of symptoms range from the mild and transient to the chronic and severe along with secondary pathologies. Balloon dilation eustachian tuboplasty (BDET) as a treatment, was first described in 2010 and has been studied extensively. This study evaluates the efficacy and safety of BDET in an Australian cohort. Methods: Retrospective chart review on all patients who underwent BDET from September 2016 to March 2020 was performed. The Eustachian Tube Dysfunction Patient Questionnaire (ETDQ‐7) was chosen as the primary outcome measure. Secondary outcome measures included subjective global assessment of presenting symptoms, ability to perform Valsalva maneuver and tympanometry. Any complications related to the procedures were reported. Results: One hundred and nineteen eustachian tube operations were included in this study. The patient cohort showed statistically significant improvement of mean EDTQ‐7 score from 0.7 to 2.9. Improvement in EDTQ‐7 was achieved in 83.9% of the cases. All patients in the baro‐challenge‐induced subgroup achieved improvement in ETDQ‐7 score. Complete resolution of symptoms with an ETDQ <2.1 was achieved in 37.1% of the cohort. There were no adverse safety events associated with the procedures. Conclusion: BDET resulted in improvement of the EDTQ‐7 score in most of patients in this Australian cohort with no reported complications. BDET was most successful in baro‐challenge‐induced subgroup with universal improvement. Lower success rates were seen in patients with secondary pathology from their ETD. [ABSTRACT FROM AUTHOR]

Objective: Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients' perspective of the surgery and their overall satisfaction with the process. Methods: A total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys. Results: The mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses. Conclusion: The series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs. [ABSTRACT FROM AUTHOR]

Abstract Objective To examine the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual and recurrent cholesteatoma in children. Methods A systematic review and meta-analysis was conducted as per PRISMA guidelines using the following databases from their date of inception: MEDLINE, PubMed, Embase, Cochrane Library, Web of Science. Bivariate meta-analysis using a random effects model was used to calculate summarized pooled estimates of sensitivity, specificity, and diagnostic odds ratios, using second-look surgery as the gold standard comparison. Results A total of ten articles (141 cases) were included for qualitative and quantitative analysis. Pooled sensitivity and specificity of non-echo planar imaging (non-EPI) DW-MRI were 89.4% (95%CI 51.9%–98.5%) and 92.9% (95%CI 81.4%–97.5%) respectively. DW-MRI appears limited in its ability to detect lesions less than 3 mm in size. Conclusion Non-EPI DW-MRI is highly specific but carries uncertain sensitivity in the detection of residual and recurrent cholesteatoma in children. Further research is warranted to determine the specific role of DW-MRI in this patient group, namely when and how often children should be referred for imaging and in which cases the method can be used to completely replace second-look surgery. [ABSTRACT FROM AUTHOR]

An abstract of the article "Protympanum: Endoscopic Anatomy, Variations and Applications" by Nicholas Jufas and others is presented.

The round window region is of critical importance in the anatomy of the middle ear. The aim of this paper is to describe its anatomy from an endoscopic point of view, emphasizing structures that have important surgical implications, in particular the fustis and the subcochlear canaliculus. The fustis, a smooth bony structure that forms the floor of the round window region, is a constant and important structure. It seems to indicate the round window membrane and the correct position of scala tympani. A structure connecting the round window region to the petrous apex, named the subcochlear canaliculus, is also described. A retrospective review of video recordings of endoscopic dissection and surgical procedures, carried out between June 2014 and February 2015, was conducted across two Tertiary university referral centers. A total of 42 dissections were analyzed in the study. We observed the fustis in all the cases and we identify two different anatomical conformations. The subcochlear canaliculus was found in 81.0 %, with a pneumatization direct to the petrous apex in 47.7 %. Conformation and limits of the round window niche may influence the surgical view of the round window membrane. Endoscopic approaches allow a very detailed view, which enables a comprehensive exploration of the round window region. Accurate knowledge of the anatomical relationships of this region has important advantages during middle ear surgery. [ABSTRACT FROM AUTHOR]

An abstract of the article "Direct Cost Comparison of Totally Endoscopic versus Open Ear Surgery" by Nirmal Patel and others is presented.

An abstract of the article "Teaching Videos of Endoscopic Middle Ear Anatomy: A Free Educational Resource" by Alexander Saxby is presented.

An abstract of the article "Comparison of CT vs CT-MRI Fusion Imaging in Assessment of Mastoid Cavity Involvement by Cholesteatoma: Implications for Endoscopic Ear Surgery" by Alexander Saxby and others is presented.