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Purpose: The purpose of this study is to determine the recurrence rate of cholesteatoma in patients who have undergone exclusive endoscopic tympanoplasty at our tertiary referral institution. A secondary objective is to analyze different clinical aspects that could be considered risk factors for recurrence to establish if it is possible to determine when a second-look procedure is indicated instead of a clinical follow-up. Methods: A retrospective study was performed on patients who had undergone exclusive endoscopic tympanoplasty for cholesteatoma in the last eight years and who were followed up for at least one year. The efficacy of the treatment performed only with the exclusive endoscopic technique was analyzed. Then, the anamnestic and intraoperative data were studied to identify possible factors that could increase the risk of recurrence. Results: The recurrence rate (14.5%) in patients (164) who underwent primary surgery with the exclusive endoscopic technique between January 2014 and January 2022 was similar to that in patients who underwent the microscopic technique with mastoidectomy in literature. In addition, we analyzed several clinical factors such as age, ossicular chain erosion, extension and localization of the cholesteatoma finding that only the last one could potentially be a risk factor for recurrence in this selected population. Conclusion: Exclusive endoscopic tympanoplasty has been shown to be effective in removing cholesteatoma in patients without evidence of mastoid involvement, with recurrence rates comparable to traditional microscopic technique and a minimally invasive approach, even considering the patient's age, ossicular chain erosion and extension of the disease. [ABSTRACT FROM AUTHOR]

Mastoid obliteration can be performed after canal wall down (CWD) mastoidectomy with various materials. Homologous bone tissue harvested from cadaver donor represents a feasible option with advantages. The purpose of the study is to describe the case of a patient diagnosed with middle ear cholesteatoma treated with mastoidectomy of the CWD and mastoid obliteration with homologous freeze‐dried corticocancellous bone particulate in the Cittadella Hospital Ear, Nose, Throat (ENT) unit. The preoperative characteristics of the patients, the procurement and processing of bone allografts, the surgical technique, and postsurgical outcomes are described. No perioperative and postoperative complications were observed, and no rejection or foreign body reactions occurred. The patient then underwent a seriated follow‐up. Audiometric tests showed an improvement in hearing levels. The volume of the neoexternal ear canal was 2.01 cm3. The case demonstrated clinical stability, substantial hearing recovery, and no need for specialist cleaning of the reformed external ear canal (EEC). The freeze‐dried bone tissue allograft, in the technical way we used, appears to be a viable option in mastoid obliteration because homologous bone is not affected by material shortage, has fast assimilation, and ensures a useful radiological examination scan, at a low cost. [ABSTRACT FROM AUTHOR]

Cerebellar abscess is a reported complication of chronic suppurative otitis media (CSOM) and is life threatening at times. It usually develops by direct spread of CSOM through the bony erosion in the petrous bone or by thrombophlebitis of the sigmoid sinus. However, an alternative pathway of infection transmission from the petrous bone to the cerebellum through the anatomical bridge of the cranial nerves has possibly not been described before. A 63-year-old female patient with CSOM and cholesteatoma developed ataxia and right facial palsy. Computed tomography (CT) showed bone erosion of the right petrous bone suggesting middle ear infection. Post-contrast MRI revealed an enhancement of swollen 7th/8th nerve complex, suggesting neuritis, and cholesteatoma in the right petrous bone. It also showed ring enhancing lesion in the cerebellar peduncle of the same side suggesting brain abscess. Surgical intervention was performed emergently and pus aspirated. She also underwent mastoidectomy and removal of cholesteatoma later by the otolaryngology team and finally got better. This case illustrates that CSOM can cause cerebellar abscess by spreading infection via anatomical bridge of the cranial nerves without direct invasion from the temporal bone or thrombophlebitis of sinus. [ABSTRACT FROM AUTHOR]

Introduction Traditional open mastoidectomy is performed through a retro-auricular incision to expose the mastoid cortex. Few have addressed the possibility of performing an endoscopic minimally invasive mastoidectomy. Objective Our objective was to test the feasibility of performing an endoscopic mastoidectomy through a 1 cm incision and burr hole. Methods Ten cadaver heads (20 mastoids) were used for this morphometric study. We performed an endoscopic mastoidectomy through a 1 cm burr hole located over the antrum. The goals were to reach predetermined landmarks and maximize the drilling of cancellous mastoid bone. Computed tomography (CT) imaging was acquired at baseline, after endoscopic approach and after traditional open mastoidectomy. The scans were then analyzed with volumetric measurements of each mastoid. Results Endoscopic mastoidectomy facilitated access to most anatomical landmarks. While open mastoidectomy enabled greater extents of mastoidectomy and tegmen exposure, the endoscopic approach exposed 76% of mastoid and 69.9% of the tegmen achievable by the open approach. Additionally, baseline mastoid volume and tegmen surface area positively correlated with the extent of mastoidectomy and tegmen exposure, respectively. Baseline mastoid volume negatively correlated with the percentage of mastoid drilled and tegmen exposed. Conclusion We demonstrated the feasibility of an endoscopic mastoidectomy through a standardized postauricular burr hole. This approach reduces the incision size and the need for soft tissue dissection. Burr hole mastoidectomy is facilitated using angled scopes which are not reliant on 0-degree line-of-sight. Although the endoscopic approach afforded slightly less exposure, the location and burr hole size can be adjusted depending on the clinical indications. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. Materials and Methods: A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Results: Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Conclusion: Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively. [ABSTRACT FROM AUTHOR]

To compare the depth of mastoid antrum on High Resolution Computed Tomography and per operatively in cases undergoing mastoidectomy. This prospective observational study was done in a tertiary care Army Hospital with 35 patients meriting cortical mastoidectomy surgery. The patients underwent HRCT of temporal bone as a routine pre-operative work up, where depth of mastoid antrum was measured from dome of lateral semicircular canal to outer cortex of temporal bone. Depth was also recorded per-operatively with the help of measuring scale. Measurements were correlated and data was analysed statistically. There were 12 male patients and 23 females. 6 patients were < 3 years of age and 29 above. Study included 29 cases of Chronic Otitis Media and 6 of Bilateral Congenital Sensorineural Hearing Loss. Mean depth of mastoid antrum was 1.625 cm ± 0.228 on HRCT, and 1.651 cm ± 0.245 per-operatively. Depths of mastoid antrum on HRCT and per operatively amongst paediatrics as well as adult cases were comparable, but were more than the standard depth of 1 cm in 5 (82.3%) paediatrics cases and ˃1.5 cm in 24 (82.9%) adult patients. In absence of Koerner's Septum, mean HRCT depth was 1.60 cm ± SD 0.23 and per operatively was 1.63 cm ± SD 0.21; whereas in its presence mean HRCT depth was 1.84 cm ± SD 0.069 and per-operatively was 1.85 cm ± SD 0.42. Significant difference in depth was noted between adults and children, and between the cases with or without Koerner's Septum. However, difference in depth was not significant when compared between different genders, laterality of disease or disease pathology. [ABSTRACT FROM AUTHOR]

Mastoid surgeries are surgical procedures, wherein surgical failures are prevalent due to the fundamental complexities involved, especially in the understanding of microscopy and pathophysiology of the disease. A revision mastoidectomy is an utmost, a post-procedure decision, wherein the patient continues to exhibit signs and symptoms that are concerning. This is proved by a prospective, cross-sectional research which was conducted upon a group of patients who were referred to a tertiary health care centre. This selection of twenty-three (23) patients who underwent mastoidectomy prior to their participation in this research, were exhibiting signs of recurrent diseases. The observations of trends seen in revision mastoidectomy are detailed and inferences gleaned from it. These trends and observations direct us towards the understanding that the majority of failure of previous mastoidectomy was due to persistent diseased air cells and recurrent or residual cholesteatoma. This is further corroborated by the trends observed from exhausting literature readings of previous similar studies. Revision mastoid surgeries are an important follow-up process, after the mastoidectomy, if the patients continue to exhibit diseased states. [ABSTRACT FROM AUTHOR]

To study the Impact of Otoendoscopy at the end of apparent microscopic clearance of disease during primary Cholesteatoma surgery in detecting the residual cholesteatoma. A prospective, interventional, non randomized and non comparative study was conducted at the ESIC Medical College and PGIMSR. All patients of chronic otitis media of squamosal type undergoing modified radical mastoidectomy were included in the study. Otoendoscopy was performed after apparent clearance of cholesteatoma under microscope. If any residual cholesteatoma detected during otoendocsopy was recorded. Total of 63 cases were included in the study. Residual cholesteatoma was seen in 14% of the cases. Commonest site of residual cholesteatoma was sinus tympani. Otoendoscopy helps in visualizing the deep recesses of the middle ear cleft for residual cholesteatoma after apparent clearance under the operating microscope. It also helps in clearing the cholesteatoma from these deep recesses there by it helps in reducing the recurrence rate of cholesteatoma. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. Methods: Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. Results: Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB). Conclusion: The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon. [ABSTRACT FROM AUTHOR]

Background: Otogenic meningitis represents the most common and life-threatening complication of infective middle ear diseases. However, no guidelines are available to describe the optimal management strategy and the role of surgical intervention. Methods: A six-year multicenter retrospective study on consecutive patients treated for otogenic meningitis caused by acute otitis and re-exacerbation of chronic otitis at the University Hospital of Verona and Modena was performed, and a systematic review regarding acute otitis media-related meningitis in accordance with the PRISMA 2020 statement was then conducted. Results: From the clinical chart analysis, 16 patients with surgical indications according to our decision-making flow chart were reviewed, with most of them undergoing surgery within 7 days of admission (n = 13, 81%). The systematic review ultimately utilized 24 studies (16 case reports and 8 case series) published between 1990 and 2023, with the overall analysis involving a total of 181 patients. Conclusion: The primary treatment for acute bacterial meningitis relies on antibiotic therapy, with surgical intervention being employed in the event of complications and when the initial treatment is not effective within 48 h. The objective of surgery is to sterilize the tympanic and mastoid cavity, thereby eradicating the suspected infective foci and managing any eventual intracranial complications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to analyse the effect of half canal wall down tympanomastoidectomy in the treatment of chronic otitis media or cholesteatoma. Method: In this retrospective study, the half canal wall down tympanomastoidectomy technique was used at our hospital for chronic otitis media or cholesteatoma removal in 265 adult patients, representing 271 operated ears, with an average follow-up time of 8.4 years. Results: The post-operative cavities were slightly wider and straighter in 91.9 per cent of the ears. Fifteen per cent of the patients needed cavity cleaning every six months, 25 per cent of them needed cavity cleaning every year and 60 per cent of the patients had a self-cleaning cavity. Only one patient with a cleft palate experienced cholesteatoma recurrence in the mesotympanum. Conclusion: The half canal wall down tympanomastoidectomy technique showed a low-recurrence rate and satisfying operative cavities. The half canal wall down tympanomastoidectomy technique is a good choice for middle ear surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim is to analyze Literature concerning mastoid obliteration in adults with either autologous or heterologous grafts in the last 10 years. Data Source: Databases such as NIH PubMed, Bookshelf, NLM Catalog, Cochrane Library, and Embase were consulted. METHODS: Thirty-seven studies were selected (22 concerning autologous materials, 15 about heterologous ones). Only studies with more than 12 months of follow-up were considered. A statistical analysis with random-effects models was performed to allow the true effect sizes to differ from study to study. RESULTS: The present literature review and meta-analysis does not allow to establish the supremacy of one technique over the other, but underlines the advantages of each reconstructive choice and the importance of mastoid obliteration in cholesteatoma surgery. The total number of obliterated ears was 2882. Overall otorrhea rate was 5% (5.2% for heterologous grafts; 4.9% for autologous materials; P < .05). Recurrent and residual cholesteatoma rate was 4.5% (3.4% in heterologous materials; 5.2% in autologous grafts; P < .05). Recurrent cholesteatoma rate was 1.8% (1.6% when using heterologous grafts, 1.9% with autologous; P < .05). Residual cholesteatoma rate was 1.5% (1.6% with heterologous materials, 1.5% with autologous; P < .05). TM (tympanic membrane) retraction pockets rate was 5.3% (3.6% with heterologous materials; P >.05; 7% with autologous materials; P < .05). TM perforations rate was 2.9% (4.3% with heterologous materials, 2.5% with autologous; P < .05). Infection rate was 2.3% (2.3% with heterologous materials, 2.2% with autologous; P < .05). CONCLUSION: Heterologous materials are associated with significantly lower rates of recurrent and residual cholesteatoma and retraction pockets development, although they are associated with higher rates of otorrhea and TM perforation. [ABSTRACT FROM AUTHOR]

Purpose: After the lifting of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic, clinical observation showed an increase in complications of acute otitis, followed by a rise in the number of mastoidectomies performed. The aim of this study was to record the number of mastoidectomies performed before, during and after the COVID-19 pandemic as an indicator for complications of acute otitis media. Methods: Data were collected from a tertiary hospital in a university setting, as well as from four major public health insurance companies in Germany. The data of 24,824,763 German citizens during a period from 2014 until 2023 were analyzed. Results: According to the data, during the COVID-19 pandemic, the number of mastoidectomies performed dropped by 54% for children aged 0–6 and by 62% for children aged 7–18. For adults, there were 30% fewer mastoidectomies performed between 2020 and 2022. After the lifting of most NPI's in the season from July 2022 to June 2023, there was a sharp increase in the number of mastoidectomies performed on patients of all ages. Conclusions: During the COVID-19 pandemic, a decrease in the number of mastoidectomies performed was seen, suggesting a lower incidence of complicated acute otitis, most likely linked to the general decrease of upper airway infections due to NPI's. In contrast, a sharp increase in the incidence of complicated otitis occurred after the hygiene measures were lifted. The current development causes a more frequent performance of mastoidectomies, thus entailing a change in the challenges for everyday clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. Methods: The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. Results: In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. Conclusion: The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery. [ABSTRACT FROM AUTHOR]

Introduction: Acute pediatric mastoiditis is a bacterial infection of the mastoid bone most commonly associated with acute otitis media. Complicated mastoiditis is traditionally characterized by intracranial complications or subperiosteal abscess, but definitions are inconsistent in the literature. Surgical intervention is identified as the main treatment for complicated mastoiditis, but there is some evidence to support medical management of uncomplicated mastoiditis. This study sought to clarify the diagnostic criteria and management of uncomplicated acute mastoiditis. Methods: All cases of acute pediatric mastoiditis were identified from a single institution over a 16-year period and reviewed for demographic and clinical data. Two different definitions of uncomplicated mastoiditis were compared; the traditional one that excluded patients with intracranial complications or subperiosteal abscess (SPA) and the proposed definition that also excluded patients with any evidence of bony erosion including coalescence, not just SPA. Univariate and multivariate analysis was conducted. Results: Eighty cases were identified. Using the traditional definition of uncomplicated mastoiditis, 46.3% of cases were uncomplicated, compared to 36.2% when using the proposed definition. Truly uncomplicated patients, categorized with the proposed definition, were treated more consistently: no patients underwent mastoidectomy and they were less likely to receive a long term course of antibiotics. On multivariate regression analysis, only categorization with the proposed definition of uncomplicated mastoiditis was independently associated with less long-term antibiotic therapy and non-surgical management. Conclusion: Uncomplicated acute mastoiditis should be defined using clinical criteria and exclude any cases with evidence of bony erosion, including coalescence or subperiosteal abscess. These truly uncomplicated patients often do not require mastoidectomy and can be prescribed a shorter course of antibiotics. Further research into treatment pathways is necessary to optimize the management of uncomplicated acute pediatric mastoiditis. [ABSTRACT FROM AUTHOR]

Introduction: Mastoidectomy is a surgical procedure that removes infection, along with cholesteatoma, from the mastoid and middle ear. Cholesteatoma, a progressive disease that erodes bone when left untreated, leads to complications. Aim: To ascertain the most common mastoidectomy-related intraoperative and postoperative complications. Materials and Methods: This study was a retrospective descriptive study of patients who underwent mastoidectomy over one year at a tertiary care hospital in Assam, India between April 2022 to March 2023. All the patients planned for mastoidectomy were evaluated for intraoperative complications like facial nerve injury or postoperative complications immediately after the postoperative period (e.g., wound dehiscence) or between 1-3 months (e.g., Sensorineural Hearing Loss (SNHL), dead ear, etc.). The data collected was tabulated in a Microsoft Excel Worksheet, and the categorical variables were summarised as proportions and percentages. Results: A total of 62 patients underwent mastoidectomy and were reviewed over the one-year period retrospectively. Out of these, 28 (45.16%) developed complications. Two out of 62 patients (3.2%) experienced facial nerve injury intraoperatively. One patient (1.6%) with a high jugular bulb experienced massive bleeding intraoperatively while raising the tympanomeatal flap. Labyrinthine injury, dural plate injury, and sigmoid sinus injury were each found in one patient (1.6%). Eight out of 62 patients (12.9%) developed persistent otorrhea. Additionally, five patients (8%) had wound dehiscence and were treated with antibacterials, antiseptic dressing, and secondary suturing when needed. Two patients (3.2%) experienced SNHL; preoperatively, they had mild conductive hearing loss which postoperatively converted to mild to moderate mixed hearing loss. Postoperative dead ear was observed in one patient (1.6%). There was one patient (1.6%) with an unfavourably displaced pinna, and two patients (3.2%) had recurrent cholesteatoma. Vertigo was seen in two cases of radical mastoidectomy and one case of modified radical mastoidectomy. Conclusion: With proper planning and sound surgical techniques, avoidance of mastoidectomy complications can be achieved.

Objective: To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition. Methods: Regional otolaryngology trainees participated in the competition. Drilling activities using the Voxel-Man TempoSurg simulator were scored by experts. Questionnaires that contained questions covering motivators for attending, perceived learning and enjoyment were sent to participants. Agreement with statements was measured on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Results: Eighteen trainees participated. The most cited reason for attending was for learning and/or education (61 per cent), with most attendees (72 per cent) believing that competition encourages more reading and/or practice. Seventeen attendees (94 per cent) believed Voxel-Man TempoSurg-based simulation would help to improve intra-operative performance in mastoidectomy (mean 7.83 ± 1.47, p < 0.001) and understanding of anatomy (mean 8.72 ± 1.13, p < 0.001). All participants rated the competition as 'fun' and 83 per cent believed the competitive element added to this. Conclusion: The virtual reality temporal bone competition is a novel educational approach within otolaryngology that was positively received by otolaryngology trainees. [ABSTRACT FROM AUTHOR]

The infrafloccular approach in microvascular decompression (MVD) surgery for hemifacial spasm (HFS) was investigated for the prevention of hearing complications. Retrospective analysis of 136 patients who underwent MVD for HFS in 2019. The infrafloccular approach for MVD was adopted to resolve the symptom and protect hearing function. Postoperative hearing function was evaluated subjectively and objectively within 30 postoperative days, and later mainly subjectively. Postoperative condition of mastoid air cells based on the CT scan of the following day was also recorded. No final postoperative subjective hearing impairment was found in all patients. Mastoid air cells were opened in 105 patients, and subjective hearing impairment was recorded in 57 patients within 30 postoperative days, but all improved later. Increases in thresholds of greater than 10 dB in air conduction were observed in 28 patients, including 26 of transient conductive hearing loss (increases in the threshold of less than or equal to 10 dB). The other 2 patients with increases in the threshold of greater than 10 dB in both air and bone conduction had improvement confirmed by later audiometry. Infrafloccular approach in MVD for HFS provides a good hearing outcome. Inclusion of postoperative hearing conditions in the later period is ideal for a precise hearing evaluation. [ABSTRACT FROM AUTHOR]

Pediatric cholesteatomas (PC) have multifactorial aetiology, spread aggressively and there are high chances of residual/ recurrent disease after treatment. The surgical technique to manage this entity has been debatable. This study was done to (i) enumerate the presentation of PC and the surgical techniques adopted (ii) analyse the outcomes viz., residual/ recurrence rates and hearing results. A cross sectional record based study was done on 618 cases of PC operated between 1983 and 2015, at a centre dedicated to otology and lateral skull base surgery. The data which was maintained on the basis of clinical and peri- operative findings was analysed. Otorrhea (59.2%) and hearing loss (54.2%) were the common symptoms. The surgeries done were: canal wall up (CWU) (44.3%), canal wall down (CWD) (41.1%), modified bondy's mastoidectomy (5.7%), radical mastoidectomy (4.9%), trans canal excision (1.8%) and subtotal petrosectomy (2.3%). The residual and recurrence rates were 12.6% and 7.9% respectively. A significant difference between the pre and post operative hearing was observed. The mean improvement in air bone gap was 7.7db. Residual/ recurrent disease were higher in CWU as compared to CWD group. The surgery should be individualised so that the patient remains disease free. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the effect of drilling during mastoidectomy on otolithic organ functions and development of benign paroxysmal positional vertigo using objective vestibular tests. Materials and methods: The study included 45 adult patients diagnosed with chronic otitis media who underwent mastoidectomy with drilling. Pre-operative and post-operative assessments included tests for subjective visual vertical deviation and videonystagmography. Results: Subjective visual vertical deviation was significantly higher in post-operative periods. On the third day, the subjective visual vertical deviation was at its maximum (1.4 degrees). Post-operatively, benign paroxysmal positional vertigo was detected in 14 patients (31.1 per cent). The most common type was ipsilateral lateral canal benign paroxysmal positional vertigo (57.1 per cent). Conclusion: The effect of drilling on otolithic organ functions in mastoidectomy seems to be temporary and subclinical; however, it potentially could be a risk factor for the development of benign paroxysmal positional vertigo. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several fixation methods have been described to secure the cochlear implant's receiver/stimulator, but the optimal stabilization technique is still being debated. The aim of this study was to compare the conventional technique with suture fixation to the subperiosteal tight pocket technique in terms of revision cochlear implantation rate. METHODS: A retrospective review was conducted on the medical records of 649 patients who underwent cochlear implantation. The study participants were divided into different groups regarding the applied surgery technique. The relationship between the fixation technique, revision rates, and the cause of revisions related to techniques was investigated. RESULTS: The overall revision rate was 2.9% (19 out of 649). There were 14 (3.5%) and 5 (2%) revision implantations in the subperiosteal tight pocket and conventional technique groups, respectively. The incidence of device failure was 2.5%, and it constituted the primary cause for revision surgery in both groups. Even though patients who had the subperiosteal tight pocket technique had a much higher rate of device failure, the results indicate that there was no significant difference between the groups, as evidenced by a P-value of .12. CONCLUSION: The conventional and subperiosteal tight pocket techniques can both be safely preferred with low revision rates in patients undergoing cochlear implantation. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. Methods: A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. Results: Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. Conclusion: Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the rate of residual disease in the Potsic staging system for congenital cholesteatomas. Methods: A protocol registration was published on PROSPERO (CRD42022383932), describing residual disease as a primary outcome and hearing improvement as secondary. A systematic search was performed in four databases (PubMed, Embase, Cochrane Library, Web of Science) on December 14, 2022. Articles were included if cholesteatomas were staged according to the Potsic system and follow-up duration was documented. Risk of bias was evaluated using the Quality In Prognosis Studies (QUIPS) tool. In the statistical synthesis a random effects model was used. Between-study heterogeneity was assessed using I2. Results: Thirteen articles were found to be eligible for systematic review and seven were included in the meta-analysis section. All records were retrospective cohort studies with high risk of bias. Regarding the proportions of residual disease, analysis using the χ2 test showed no statistically significant difference between Potsic stages after a follow-up of minimum one year (stage I 0.06 (confidence interval (CI) 0.01–0.33); stage II 0.20 (CI 0.09–0.38); stage III 0.06 (CI 0.00–0.61); stage IV: 0.17 (CI 0.01–0.81)). Postoperative and preoperative hearing outcomes could not be analyzed due to varied reporting. Results on cholesteatoma location and mean age at staging were consistent with those previously published. Conclusion: No statistically significant difference was found in the proportions of residual disease between Potsic stages, thus the staging system's applicability for outcome prediction could not be proven based on the available data. Targeted studies are needed for a higher level of evidence. [ABSTRACT FROM AUTHOR]

Background and Objectives: Various materials are used to perform post-mastoidectomy mastoid obliteration (MO) to reduce the risk of recurrent infections, stasis of secretions, or caloric dizziness. Autologous materials used as fillers for MO tend to be insufficient owing to shrinkage over time or inadequate volume of these substances. Synthetic materials are unsatisfactory for MO because of the risk of rejection and extrusion. We investigated the safety and effectiveness of bone allografts for post-mastoidectomy MO. Subjects and Methods: We reviewed the medical records of patients who underwent mastoidectomy with MO between January 2013 and January 2021. In the MO group, bone allografts were additionally used to fill the residual mastoid cavity. In the canal wall down (CWD) group, all patients underwent CWD mastoidectomy with use of additional inferiorly based mucoperiosteal flaps. Results: The study included the MO group (23 ears) and the CWD group (53 ears). In the MO group, compared with the preoperative status, we observed a decrease in the tendency of the air-bone gap postoperatively. Compared with the CWD group, the total complication rate showed a decreasing tendency in the MO group. Conclusions: No patient showed post-MO shrinkage of the grafted bone allograft or otorrhea. Further large-scale studies are warranted to confirm the advantages of bone allografts for MO, including maintenance with time and sufficient amount. [ABSTRACT FROM AUTHOR]

Background: Adenoid cystic carcinoma is an uncommon malignancy primarily arising from salivary glands. An extremely rare site for adenoid cystic carcinoma is the skull base. We report a case of adenoid cystic carcinoma of skull base who presented with common complaints of pain and right ear discharge. The discussion is made with emphasis on imaging evaluation simulating infective etiology with adjacent skull base osteomyelitis. Careful observation of the imaging findings and further evaluation of the patient revealed the neoplastic nature of the lesion with the final diagnosis being adenoid cystic carcinoma. Case presentation: A 40-year-old female presented to our department with complaints of pain and right ear discharge since 6 months with progressive, extensive facial swelling and facial nerve palsy. The patient had undergone modified radical mastoidectomy thrice, but the details were not available. On imaging, there was a heterogenous extensive lesion extending from scalp till upper cervical region with extensive destruction of skull base and intra-cranial extension. The possibilities of temporal bone squamous cell carcinoma and extensive skull base osteomyelitis were considered. Further the biopsy of the lesion revealed adenoid cystic carcinoma. Conclusions: Extensive lesions of the skull base can be of infective, neoplastic and inflammatory etiology. Distinguishing between these conditions is crucial, as they have similar imaging characteristics but require different management approaches. The presence of a lesion that displaces or destroys fascial planes, accompanied by solid mass-like enhancement, indicates a higher probability of a neoplastic origin rather than an infectious etiology. With squamous cell carcinoma being the most common neoplasm, adenoid cystic carcinoma of the skull base also needs to be understood due to its propensity for perineural spread and a high likelihood of recurrence. [ABSTRACT FROM AUTHOR]

Background: To compare the diagnostic value of 120-kV with conventional 96-kV Cone-Beam CT (CBCT) of the temporal bone after cochlear implant (CI) surgery. Methods: This retrospective study included CBCT scans after CI surgery between 06/17 and 01/18. CBCT allowed examinations with 96-kV or 120-kV; other parameters were the same. Two radiologists independently evaluated following criteria on 5-point Likert scales: osseous spiral lamina, inner and outer cochlear wall, semi-circular canals, mastoid trabecular structure, overall image quality, metal and motion artefacts, depiction of intracochlear electrode position and visualisation of single electrode contacts. Effective radiation dose was assessed. Results: Seventy-five patients (females, n = 39 [52.0%], mean age, 55.8 ± 16.5 years) were scanned with 96-kV (n = 32, 42.7%) and 120-kV (n = 43, 57.3%) protocols including CI models from three vendors (vendor A n = 7; vendor B n = 43; vendor C n = 25). Overall image quality, depiction of anatomical structures, and electrode position were rated significantly better in 120-kV images compared to 96-kV (all p < = 0.018). Anatomical structures and electrode position were rated significantly better in 120-kV CBCT for CI models from vendor A and C, while 120-kV did not provide improved image quality in CI models from vendor B. Radiation doses were significantly higher for 120-kV scans compared to 96-kV (0.15 vs. 0.08 mSv, p < 0.001). Conclusions: 120-kV and 96-kV CBCT provide good diagnostic images for the postoperative CI evaluation. While 120-kV showed improved depiction of temporal bone and CI electrode position compared to 96-kV in most CI models, the 120-kV protocol should be chosen wisely due to a substantially higher radiation exposure. [ABSTRACT FROM AUTHOR]

Significance Statement: Primary middle ear inverted papilloma is an exceedingly rare finding posing a diagnostic challenge, as symptomatology often mimics common clinical entities like serous otitis media. Clinical and radiological findings are not specific, whilst high recurrence rates, local destruction, and potential malignant transformation constitute an overall demanding surgical challenge, requiring aggressive procedures. We report the case of a primary inverted papilloma of the middle ear, discussing diagnostic and therapeutic issues. [ABSTRACT FROM AUTHOR]

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]

Ossicular destruction is a common phenomenon in chronic otitis media due to an imbalance between osteoblasts and osteoclasts. Computed tomography helps us in the assessment of ossicular status, extent of pneumatization, and early identification of complications. This study aims to check the diagnostic accuracy of computed tomography temporal bone for the detection of ossicular erosion in comparison with the surgical findings taken as a gold standard. The use of this investigation as an adjunct can prove to be helpful in planning mastoid exploration as well as a primary reconstruction surgery especially in mucosal and early squamosal diseases. It's a cross-sectional validation study done on 50 patients with chronic otitis media (both mucosal and squamous type) from July 2022 to November 2023. Patients underwent CT scanning of temporal bone and ossicular status was reported by the radiologist. Later on, mastoid surgery was carried out and per operative findings were documented. 2 × 2 tables were formed and diagnostic accuracy of CT temporal bone was checked in terms of sensitivity, specificity, negative predictive value, and positive predictive value. The results revealed that CT temporal bone has a high diagnostic accuracy with a sensitivity of 92.5% and specificity of 100% for malleus (p value < 0.001). For incus and stapes, sensitivity came out to be 93.5% and 76% respectively and specificity values were 94.7% and 100% (p value < 0.001 for all) giving a verdict that the pre-operative use of this radiological investigation should be encouraged by otologists. [ABSTRACT FROM AUTHOR]

Introduction: While placing the Proseal-laryngeal Mask Airway (PLMA) using the digital technique, there may be failed insertion or inadequate ventilation. Therefore, a placement technique using the Gum Elastic Bougie (GEB)-aided placement was employed. Aim: To compare the clinical efficacy of Proseal Laryngeal Mask Airway (PLMA) insertion by two different techniques viz. Digital and Gum elastic bougie-aided, in mastoid surgery in adult patients done under General Anaesthesia. Materials and Methods: In this randomised clinical study conducted at the Department of Anaesthesiology, R.G. Kar Medical College, Kolkata, West Bengal, India from November 2016 to December 2022. A total of 88 patients of American Society of Anaesthesiologists (ASA) class I and II of either sex undergoing mastoid surgery using the PLMA as an airway management device were allocated to Digital (Group D) and gum elastic Bougie (Group B) techniques. Parameters studied included the percentage of successful insertion of PLMA on the first attempt, number of attempts required and time taken for successful insertion of PLMA and postoperative complications if any. The t-test was used to compare the groups regarding PLMA insertion time, while categorical data such as airway trauma was compared using Chisquare test or Fischer's-exact test (whichever applicable). Results: In the present study 88 patients were included, with 44 patients in each of the two groups. The difference in Mallampati scoring of both groups was statistically insignificant. In the present study 68.18% patients in Gum elastic bougie group and 70.45% patients in Digital group were of ASA Grade I, showing no statistical significance between these two groups regarding ASA status. In Group B (GEB), PLMA was successfully inserted in 95.45% of cases on the first attempt, and in group D (digital) the corresponding figure was 77.27% and 22.72% of cases required a 2nd attempt, this difference was statistically significant (p-value<0.001). The difference of PLMA insertion mean time was statistically significant between the two groups (24.33±3.209 seconds in gum elastic bougie group whereas in digital group it was 13.42±3.228 seconds) (p-value <0.001). Conclusion: The GEB-aided Proseal-LMA insertion is more successful in the first attempt than in the digital technique. Although GEB-aided insertions of PLMA took longer, they helped achieve higher oropharyngeal leak pressure. With peak airway pressures less than 20 cm of H2O there was no audible leak from the drain tube and there were fewer failed insertions. [ABSTRACT FROM AUTHOR]

Introduction: Mastoidectomy is a surgical procedure that removes infection, along with cholesteatoma, from the mastoid and middle ear. Cholesteatoma, a progressive disease that erodes bone when left untreated, leads to complications. Aim: To ascertain the most common mastoidectomy-related intraoperative and postoperative complications. Materials and Methods: This study was a retrospective descriptive study of patients who underwent mastoidectomy over one year at a tertiary care hospital in Assam, India between April 2022 to March 2023. All the patients planned for mastoidectomy were evaluated for intraoperative complications like facial nerve injury or postoperative complications immediately after the postoperative period (e.g., wound dehiscence) or between 1-3 months (e.g., Sensorineural Hearing Loss (SNHL), dead ear, etc.). The data collected was tabulated in a Microsoft Excel Worksheet, and the categorical variables were summarised as proportions and percentages. Results: A total of 62 patients underwent mastoidectomy and were reviewed over the one-year period retrospectively. Out of these, 28 (45.16%) developed complications. Two out of 62 patients (3.2%) experienced facial nerve injury intraoperatively. One patient (1.6%) with a high jugular bulb experienced massive bleeding intraoperatively while raising the tympanomeatal flap. Labyrinthine injury, dural plate injury, and sigmoid sinus injury were each found in one patient (1.6%). Eight out of 62 patients (12.9%) developed persistent otorrhea. Additionally, five patients (8%) had wound dehiscence and were treated with antibacterials, antiseptic dressing, and secondary suturing when needed. Two patients (3.2%) experienced SNHL; preoperatively, they had mild conductive hearing loss which postoperatively converted to mild to moderate mixed hearing loss. Postoperative dead ear was observed in one patient (1.6%). There was one patient (1.6%) with an unfavourably displaced pinna, and two patients (3.2%) had recurrent cholesteatoma. Vertigo was seen in two cases of radical mastoidectomy and one case of modified radical mastoidectomy. Conclusion: With proper planning and sound surgical techniques, avoidance of mastoidectomy complications can be achieved. [ABSTRACT FROM AUTHOR]

Background: While mastoid obliteration techniques have received much attention in decreasing the disadvantages associated with the resultant mastoid cavity from canal wall down procedures, techniques for an anatomically normal looking ear canal reconstruction to increase the feasibility of hearing aid fitting are less commonly discussed as an alternative. Methods: Our mastoidoplasty technique basically utilises an inferiorly based periosteal flap with or without temporalis muscles and fascia to obliterate the epitympanum and reconstruct the external auditory canal (EAC). Stay sutures are used to keep them in place. For larger cavities, demineralized bone matrix (DBM) is used to obliterate the mastoid cavity and support the neo-EAC. Conclusions: The concept of our mastoidoplasty potentially provides a very useful alternative in recreating a near normal ear canal anatomy avoiding cavity problems as well as facilitating hearing aid fitting with canal type hearing aids after canal wall down mastoidectomy. [ABSTRACT FROM AUTHOR]

Purpose: The narrow supralabyrinthine space affects surgical procedures. To study the effect of temporary transposition of geniculate ganglion of facial nerve versus nontransposition on lesion recurrence and facial nerve function in patients with petrous bone cholesteatoma. Methods: A total of 18 patients with petrous bone cholesteatoma involving the facial nerve were treated in our hospital from November 2016 to March 2023. The main surgical method is the extended supralabyrinthine approach assisted by a microscope and an endoscope. We collected and retrospectively analyzed their medical records. Results: Temporary facial nerve transposition was performed in five patients, and nontransposition was performed in 13 patients. Cholesteatoma recurred in three patients with facial nerve nontransposition, whereas none in patients with facial nerve transposition. In this study, except for one case with a second operation, postoperative facial paralysis in other cases was improved to varying degrees, and there was no significant difference between the two groups. Conclusion: Temporary transposition of geniculate ganglion of facial nerve will not affect the postoperative nerve function of patients and can reduce the possibility of cholesteatoma recurrence of the petrous bone. [ABSTRACT FROM AUTHOR]

Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing. This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25). The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss. Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution. [ABSTRACT FROM AUTHOR]

Background: Subtotal petrosectomy (STP) has attracted massive interest over last two decades. The aim is to present our experience of this uncommon surgery. The indications, outcomes, and our variation in surgical technique would be presented and literature reviewed. Methods: A retrospective observational study of all patients who underwent STP at a tertiary care center in India was analyzed. Results: A total of 9 ears (in 8 patients) underwent STP over last 5 years at our center. The pathological conditions for which STP was done included chronic otitis media squamous (four ears), middle ear tumors (three ears), petrous apicitis (one ear), and traumatic cerebrospinal fluid (CSF) otorhinorrhea (one ear). The indication of STP included disease clearance (eight ears), unserviceable hearing (seven ears), hearing rehabilitation with otological implants (six ears), and intraoperative CSF gusher (one ear). Intraoperative indications included CSF gusher, large tegmen defect with erosion of apical turn of cochlea, and erosion of anterior bony wall of external auditory canal. The mean follow-up period was 36 months (range of 6 months to 60 months). None of the patients had any dehiscence of blind sac closure or secondary acquired cholesteatoma on imaging. Conclusions: STP facilitates disease clearance by providing unmatchable exposure in difficult otological scenarios and additionally isolates middle ear cleft from external environment, thereby eliminating problems of mastoid cavity. Furthermore, it also prepares ear for second stage otological implants. It is a safe surgery with minimal complications. [ABSTRACT FROM AUTHOR]

Objective: To develop a convolutional neural network‐based computer vision model to recognize and track 2 mastoidectomy surgical instruments—the drill and the suction‐irrigator—from intraoperative video recordings of mastoidectomies. Study Design: Technological development and model validation. Setting: Academic center. Methods: Ten 1‐minute videos of mastoidectomies done for cochlear implantation by varying levels of resident surgeons were collected. For each video, containing 900 frames, an open‐access computer vision annotation tool was used to annotate the drill and suction‐irrigator class images with bounding boxes. A mastoidectomy instrument tracking module, which extracts the center coordinates of bounding boxes, was developed using a feature pyramid network and layered with DETECTRON, an open‐access faster—region‐based convolutional neural network. Eight videos were used to train the model, and 2 videos were used for testing. Outcome measures included Intersection over Union (IoU) ratio, accuracy, and average precision. Results: For an IoU of 0.5, the mean average precision for the drill was 99% and 86% for the suction‐irrigator. The model proved capable of generating maps of drill and suction‐irrigator stroke direction and distance for the entirety of each video. Conclusions: This computer vision model can identify and track the drill and suction‐irrigator from videos of intraoperative mastoidectomies performed by residents with excellent precision. It can now be employed to retrospectively study objective mastoidectomy measures of expert and resident surgeons, such as drill and suction‐irrigator stroke concentration, economy of motion, speed, and coordination, setting the stage for characterization of objective expectations for safe and efficient mastoidectomies. [ABSTRACT FROM AUTHOR]

Abstract Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator’s educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.

Chronic suppurative otitis media (CSOM) is a leading global cause of potentially preventable hearing loss in children and adults, associated with socioeconomic deprivation. There is an absence of consensus on the definition of CSOM, which complicates efforts for prevention, treatment, and monitoring. CSOM occurs when perforation of the tympanic membrane is associated with severe or persistent inflammation in the middle ear, leading to hearing loss and recurrent or persistent ear discharge (otorrhoea). Cholesteatoma, caused by the inward growth of the squamous epithelium of the tympanic membrane into the middle ear, can also occur. The optimal treatment of discharge in CSOM is topical antibiotics. In resource-limited settings where topical antibiotics might not be available, topical antiseptics are an alternative. For persistent disease, surgery to repair the tympanic membrane or remove cholesteatoma might offer long-term resolution of otorrhoea and potential improvement to hearing. Recent developments in self-fitted air-conduction and bone-conduction hearing aids offer promise as new options for rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The development of temporal bone pneumatization is related to the postnatal middle ear environment, where the development of air cells is suppressed with otitis media in early childhood. However, whether air cell formation restarts when mastoidectomy is performed during temporal bone pneumatization remains unclear. Herein, we evaluated temporal bone pneumatization after canal wall up (CWU) tympanomastoidectomy for middle ear cholesteatoma in children. Methods: In total, 63 patients, including 29 patients with congenital cholesteatoma (CC) and 34 patients with acquired cholesteatoma (AC), were assessed using a set of pre- and postoperative computed tomography images. The air cells of the temporal bone were divided into five areas: periantral (anterior), periantral (posterior), periantral (medial), peritubal, and petrous apex. The number of areas with air cells before and after surgery was compared to evaluate temporal bone pneumatization after surgery. Results: A total of 63 patients, comprising 29 with CC and 34 with AC (pars flaccida; 23, pars tensa; 7, unclassified; 4), were evaluated. The median age of patients (18 males and 11 females) with CC was 5.0 (range, 2–15 years), while that of the AC group (23 males and 11 females) was 8 (range, 2–15 years). A significant difference in air cell presence was identified in the CC and AC groups after surgery (Mann–Whitney U, p < 0.001 and p = 0.003, respectively). Between the two groups, considerably better postoperative pneumatization was observed in the CC group. A correlation between age at surgery and gain of postoperative air cell area development was identified in the CC group (Spearman's rank-order correlation coefficient, r = −0.584, p < 0.001). In comparison with the postoperative pneumatization rate of each classified area, the petrous apex area was the lowest in the CC and AC groups. Conclusions: Newly developed air cells were identified in the temporal bones after CWU mastoidectomy for pediatric cholesteatoma. These findings may justify CWU tympanomastoidectomy, at least for younger children and CC patients, who may subsequently develop air cell systems after surgery. [ABSTRACT FROM AUTHOR]

Background: Individuals with severe motor and intellectual disabilities have become an aging population, and high cancer morbidity and mortality are critical issues affecting their survival. Cancer screening is a crucial method of resolving this issue; however, a suitable screening method for them has not been established. Methods: We used ultrasonography alone and performed breast cancer screening for women over 30 years old in our facility from 2016 to 2023. We observed the outcomes and calculated the recall/detection rate in this screening. Results: Three cases among 379 tested positive in this screening, all of which underwent radical surgery. They are alive and well without relapse present. We detected these breast cancer cases with a low recall rate. Conclusion: We were able to successfully detect breast cancer cases using ultrasonography alone. Ultrasonography is an effective and feasible tool for breast cancer screening in individuals with severe motor and intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cholesteatoma presents significant management challenges in otolaryngology. This study aimed to delineate the influence of demographic and clinical characteristics, preoperative imaging, and surgical approaches on treatment success in cholesteatoma management. Methods: A cross-sectional analytical study was conducted at the Otolaryngology Department of the University Hospital from January 2021 to December 2022. It included 68 patients diagnosed with cholesteatoma, focusing on three objectives: assessing the impact of demographic and clinical characteristics on treatment outcomes, evaluating the predictive value of preoperative imaging findings, and analyzing the influence of surgical factors. Results: The study population predominantly consisted of male (56%) and Saudi (81%) patients, with an average age of 45 years. Logistic regression revealed that older age (OR: 1.05), male gender (OR: 0.63), and non-Saudi Arab ethnicity (OR: 2.14) significantly impacted treatment outcomes. Clinical characteristics such as severe disease severity (OR: 3.00) and longer symptom duration (OR: 0.96) also influenced treatment success. In preoperative imaging, labyrinthine fistula (Regression Coefficient: 0.63) and epidural extension (Coefficient: 0.55) emerged as key predictors. The surgical factors that significantly affected the outcomes included the extent of surgery (Complete Removal OR: 3.32) and the use of endoscopic approaches (OR: 1.42). Conclusions: This study highlights that patient demographics, clinical profiles, specific preoperative imaging features, and surgical strategies multifactorially determine cholesteatoma treatment success. These findings suggest the necessity for a tailored approach in cholesteatoma management, reinforcing the importance of individualized treatment plans based on comprehensive preoperative assessments. [ABSTRACT FROM AUTHOR]

Background: Cholesteatoma is a lesion capable of destroying surrounding tissues, which may result in significant complications. Surgical resection is the only effective treatment; however, the presence of cholesteatoma recidivism is common. This study evaluated the effectiveness of the Attic Exposure-Antrum Exclusion (AE-AE) surgical technique in treating cholesteatomas and identifying factors associated with recidivism. Additionally, the study aimed to assess the utility of non-echo-planar diffusion MRI (non-EPI-DWI MRI) in detecting cholesteatoma recidivism in patients undergoing AE-AE surgery. Methods: The study involved 63 patients who underwent AE-AE surgery for primary acquired cholesteatoma and were followed up clinically and radiologically for at least five years. The radiological follow-up included a non-EPI-DWI MRI. Results: Results showed that the AE-AE technique successfully treated cholesteatomas, with a recidivism rate of 5.2%. The study also found that non-EPI-DWI MRI was a useful diagnostic tool for detecting cholesteatoma recidivism, although false positives could occur due to the technique's high sensitivity. As Preoperative Pure-tone average (PTA) increases, there is a higher probability of cholesteatoma recidivism in imaging tests (p = 0.003). Conclusions: Overall, the study highlights the importance of the AE-AE surgical technique and non-EPI-DWI MRI in managing cholesteatoma recidivism in patients, providing valuable insights into associated risk factors and how to manage recidivism. Non-EPI-DWI MRI can assist in patient selection for revision surgery, reducing unnecessary interventions and associated risks while improving treatment outcomes and patient care. [ABSTRACT FROM AUTHOR]

Nervus intermedius (NI) arises from the superior salivary nucleus, solitary nucleus, and trigeminal tract. It leaves the pons as 1 to 5 roots and travels between the facial and vestibulocochlear nerves before merging with the facial nerve within the internal auditory canal. The mastoid segment of the facial nerve then gives rise to a sensory branch that supplies the posteroinferior wall of the external auditory meatus and inferior pina. This complex pathway renders the nerve susceptible to various pathologies, leading to NI neuralgia. Here, the authors present an unusual intraoperative finding of an atrophic NI in a patient with refractory NI neuralgia and a history of ipsilateral sudden-onset central facial palsy and microvascular decompression for trigeminal neuralgia. The patient underwent NI sectioning via the previous retrosigmoid window and achieved partial ear pain improvement. The gross size of the NI is compared with a cadaveric specimen through stepwise dissection. This case highlights the potential significance of subtle central ischemic events and subsequent atrophy of NI in the pathogenesis of NI neuralgia, as well as the ongoing need to investigate the therapeutic efficacy of nerve sectioning. [ABSTRACT FROM AUTHOR]

Purpose: The endoscopic trans-eustachian approach (ETETA) is a less invasive approach to the infratemporal fossa (ITF), providing superior exposure compared to traditional transcranial approaches. The anatomy of the pharyngotympanic (eustachian) tube and adjacent neurovascular structures is complex and requires in-depth knowledge to safely perform this approach. We present a cadaveric and radiological assessment of critical anatomic considerations for ETETA. Methods: Six adult cadaveric heads were dissected alongside examination of 50 paranasal sinus CT scans. Key anatomic relationships of the pharyngotympanic tube and adjacent structures were qualitatively and quantitatively evaluated. Descriptive statistics were performed for quantitative data. Results: Anatomical and radiological measurements showed lateralization of the pharyngotympanic tube allows access to the ITF. The pharyngotympanic tube has bony and cartilaginous parts with the junction formed by the sphenoid spine and foramen spinosum. The bony part and tendon of the tensor tympani muscle were located at the posterior genu of the internal carotid artery. The anterior and inferior wall of the carotid canal was located between the horizontal segment of the internal carotid artery and petrous segment of the cartilaginous pharyngotympanic tube. Conclusion: The combination of preoperative radiographic assessment and anatomical correlation demonstrates a safe and effective approach to ETETA, which allowed satisfactory visualization of ITF. The morphological evaluation showed that the lateralization of the pharyngotympanic tube and related structures allowed a surgical corridor to reach the ITF. Endoscopic surgery through the pharyngotympanic tube is challenging, and in-depth understanding of the key anatomic relationships is critical for performing this approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although advanced technologies and surgical procedures are used, cholesteatoma is a disease with the possibility of recurrence. The aim of this study was to determine the long-term effect of sodium 2-mercaptoethane sulfonate (MESNA) on cholesteatoma surgery. METHODS: Patients who underwent cholesteatoma surgery between January 2009 and July 2014 by the same surgeon were divided into 2 groups: those where MESNA was used and those where it was not. Otomicroscopic examinations were performed to see the presence of cholesteatoma recurrence in the patients who had surgery at least 8 years ago. Pure-tone audiometry was performed to evaluate the hearing results. RESULTS: Sodium 2-mercaptoethane sulfonate was used in 23 patients and was not used in 39 patients who came to the control. In the MESNAused group, cholesteatoma was seen in only 1 of the patients who underwent a canal wall-down (CWD) mastoidectomy. In the MESNA non-used group, cholesteatoma was seen in 3 patients who underwent CWD. The difference was not statistically significant. CONCLUSION: Although there was no statistically significant difference, recurrence of cholesteatoma was seen less frequently in patients who received MESNA during surgery. Studies to be conducted in larger patient series may clarify this issue. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of this article is to determine the efficacy of otoendoscopy during microscopic cholesteatoma surgery on residual cholesteatoma rates postoperatively. METHODS: The medical records of patients (aged 4-90) with primary acquired cholesteatoma who underwent microscopic cholesteatoma surgery (exclusively transcanal approach or canal wall-up tympano-mastoidectomy) with subsequent otoendoscopic examination (80 ears) for intraoperative cholesteatoma residues were retrospectively reviewed. All cases with mixed microscopic/endoscopic, fully endoscopic, or fully microscopic dissection were excluded, as well as cases where a canal wall-down technique was used. After microscopic cholesteatoma removal, the otoendoscope was used to inspect the middle ear recesses for intraoperative cholesteatoma residues. The intra- and postoperative cholesteatoma residue rate were evaluated. RESULTS: On endoscopic examination, intraoperative cholesteatoma residues were encountered in 24 patients (30%). A total of 30 foci were detected. Most of them were found in the superior retrotympanum (15 foci). In 9 cases an antral remnant guided the surgeon to convert to a canal wall up tympanomastoidectomy. During the postoperative follow-up period, residual cholesteatoma was detected on postoperative magnetic resonance imaging in 6 patients (7.5%). Adding an otoendoscopic examination to microscopic cholesteatoma surgery reduced the postoperative cholesteatoma residues rate (odds ratio=0.16). A negative otoendoscopic examination led to a cholesteatoma residue-free follow-up period in 95% of cases(NPV=0.95). CONCLUSION: Otoendoscopy is effective in identifying intraoperative cholesteatoma residues after microscopic cholesteatoma surgery. It reduces the postoperative cholesteatoma residue rate, and a negative otoendoscopic examination increases the likelihood of a cholesteatoma residue-free follow-up. [ABSTRACT FROM AUTHOR]

Background: Radical mastoidectomy is the outstanding standard technique for management of cholesteatoma. Long term studies showed increasing incidence of discharging cavities (1). Modified radical mastoidectomy was described to prevent recurrent cholesteatoma along with reconstruction of the ossicular hearing mechanismre. Exteriorization of the disease bearing areas is essential for effective follow up (2). However, there are many recesses which cannot be exteriorized regarding its anatomical location such as the mesotympanum. It will be a source of discharge or accumulation of keratin. Covering these recesses by grafting is an essential rather than optional step in all radical mastoidectomies to prevent problematic cavities. Aim of work: Demonstrate the necessity of grafting in radical mastoidectomy for obtaining dry cavity. Methods: A prospective, comparative study conducted from March 2016 to October 2019 on 60 cholesteatoma patients. Patients were randomized into 2 equal groups of 30 patients each. In group A, patients undergone modified radical mastoidectomy with grafting, while patients in group B have undergone radical mastoidectomy without grafting. Regular follow-up was done monthly for 1 year for both groups. Results: In group A, 22 patients have intact grafts, and dry well epithelialized cavities, 2 patients had perforated grafts, 5 patients had small discharging granulations and 1 patient had a keratin pearl under the graft. In group B, 19 patients suffered persistent discharging cavity, 8 patients had less discharge with keratin debris and granulations and 3 patients had dry cavities. Conclusions: Grafting is an essential step in radical mastoidectomy to prevent cavity problems. [ABSTRACT FROM AUTHOR]

A study published in Clinical Otolaryngology compares the use of the VITOM-3D exoscope and the traditional operating microscope for major ear surgery. The study finds that the exoscope can be a viable alternative, with similar outcomes in terms of complications, graft status, audiometric results, and cholesteatoma recurrence. However, it is important to carefully select cases for the exoscope and note that it is not compatible with KTP lasers. The study provides valuable insights into the use of this technology in otolaryngology, but further research is needed to address its limitations and fully understand its potential. [Extracted from the article]

Objective: To describe characteristics of pediatric patients with recurrent acute mastoiditis, and to identify risk factors for this condition. Study design: A retrospective cohort study. Setting: Data based on electronic medical records of the largest Health Maintenance Organization in Israel. Methods: Children hospitalized due to acute mastoiditis during the years 2008–2018 were identified, and their diagnosis was verified. Patients with recurrent acute mastoiditis were identified and grouped, and their characteristics were outlined and compared to those of the original group to identify risk factors for recurrence. Results: During the 11-year period, a total of 1115 cases of children hospitalized due to acute mastoiditis were identified with a weighted incidence rate of 7.8/100,000. Of this group, 57 patients were diagnosed with recurrence following a full clinical recovery. The incidence proportion of recurrent acute mastoiditis was 5.1% (57/1115), male-to-female ratio was 27:30, 73.4% were younger than 24 months, the median period from the first episode was 3.4 months (IQR 2.0;10.0), and 82.5% of the patients (n = 47) had a single recurrence, whereas 18.5% (n = 10) had two recurrences or more. Mastoidectomy and swelling over the mastoid area during the first episode were identified as the main risk factors for recurrent mastoiditis HR = 4.7 [(2.7–8.2), p < 0.001] and HR = 2.55 [(1.4–4.8), p = 0.003], respectively. Mastoidectomy was the only independent significant risk factor for recurrence in a multivariate analysis. Conclusions: Mastoidectomy and swelling over the mastoid area during the first episode of acute mastoiditis were found strongly related independent risk factor for future recurrent episodes of acute mastoiditis. [ABSTRACT FROM AUTHOR]