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Surgical management of middle ear cholesteatoma and reconstruction at the same time.

Blanco P, González F, Holguín J, Guerra C - Colomb. Med. (2014)

Bottom Line: Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up.Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Professor. Specialization in Otology and Neuro-Otology, University of Valle. Cali, Colombia.

ABSTRACT

Introduction: In the surgical management of cholesteatoma, one can opt for a closed technique (simple mastoidectomy) or open surgery (radical mastoidectomy). Open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery combines the advantages of both techniques, namely, adequate surgical exposure, eradication of cholesteatoma, and anatomical reconstruction of the middle ear structures.

Objective: To evaluate the surgical results in the management of cholesteatoma through the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery.

Methods: Prospective analytical observational study conducted between 2009 and 2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle [University Hospital of Valle], performing preoperative clinical monitoring and quarterly postoperative tomography with previous assessments of hearing and pre- and postoperative audiometry.

Results: Forty-five patients were studied. Mean postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15). Residual cholesteatoma was present in 6.6% of cases; three to four times lower than the rate reported in the literature.

Conclusions: This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases.

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Related in: MedlinePlus

Diagram of open mastoidectomy (CWU) with reconstruction of the posterosuperior wall and middle ear in one surgery. A. One retro-auricular incision is made. B. Mastoid approach with traditional milling. The posterior wall of the EAC was milled to completely expose the facial recess, tympanic sinus, and hypotympanum. C. Milling of the COG (epitympanic ridge dividing the anterior tympanum from the posterior) in the epitympanum until completely exposed (exposure of the anterior and posterior epitympanum). Cholesteatoma was resected, and all spaces were cleaned. D. Mastoid occlusion was performed with powdered bone, cartilage, muscle, and/or temporal fascia. For reconstruction of the ossicular chain, autologous material or titanium prosthesis was used (PORP or TORP)
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f01: Diagram of open mastoidectomy (CWU) with reconstruction of the posterosuperior wall and middle ear in one surgery. A. One retro-auricular incision is made. B. Mastoid approach with traditional milling. The posterior wall of the EAC was milled to completely expose the facial recess, tympanic sinus, and hypotympanum. C. Milling of the COG (epitympanic ridge dividing the anterior tympanum from the posterior) in the epitympanum until completely exposed (exposure of the anterior and posterior epitympanum). Cholesteatoma was resected, and all spaces were cleaned. D. Mastoid occlusion was performed with powdered bone, cartilage, muscle, and/or temporal fascia. For reconstruction of the ossicular chain, autologous material or titanium prosthesis was used (PORP or TORP)

Mentions: This paper describes a prospective observational study, using as a sample patients seen at the ear clinic of the Otology and Neuro-Otology service of the University Hospital of Valle in the period between 2009 and 2012. Men and women between 5 and 80 years old diagnosed with cholesteatomatous chronic otomastoiditis who underwent open mastoidectomy with reconstruction in the same surgery were included (Fig. 1A, B, C, D and Fig. 2). Patients for whom surgery was unable to completely remove the cholesteatoma at the first intervention and patients with systemic diseases that contraindicated surgery (according to anesthesiology criteria) were excluded. Postoperative follow-up was conducted at 3, 6 and 12 months, assessing symptoms and findings upon physical examination. Audiometry was tested before surgery, and imaging studies, such as simple scanning (CT) of the middle ear with coronal and axial slices, were conducted. Audiometry was interpreted based on the auditory pure tone average (PTA), which is the average in decibels (dB) at which a patient perceives pure tones at frequencies of 500, 1,000 and 2,000 Hz. Postoperative audiometry was conducted at three months. Statistical analysis of the auditory difference before and after surgery with the paired samples statistic was performed in SPSS. Postoperative MRI ECO-SPIN was requested within a year. The chi-squared test (Χ2) was performed in STATA® 11 to examine the correlation of variables.


Surgical management of middle ear cholesteatoma and reconstruction at the same time.

Blanco P, González F, Holguín J, Guerra C - Colomb. Med. (2014)

Diagram of open mastoidectomy (CWU) with reconstruction of the posterosuperior wall and middle ear in one surgery. A. One retro-auricular incision is made. B. Mastoid approach with traditional milling. The posterior wall of the EAC was milled to completely expose the facial recess, tympanic sinus, and hypotympanum. C. Milling of the COG (epitympanic ridge dividing the anterior tympanum from the posterior) in the epitympanum until completely exposed (exposure of the anterior and posterior epitympanum). Cholesteatoma was resected, and all spaces were cleaned. D. Mastoid occlusion was performed with powdered bone, cartilage, muscle, and/or temporal fascia. For reconstruction of the ossicular chain, autologous material or titanium prosthesis was used (PORP or TORP)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225790&req=5

f01: Diagram of open mastoidectomy (CWU) with reconstruction of the posterosuperior wall and middle ear in one surgery. A. One retro-auricular incision is made. B. Mastoid approach with traditional milling. The posterior wall of the EAC was milled to completely expose the facial recess, tympanic sinus, and hypotympanum. C. Milling of the COG (epitympanic ridge dividing the anterior tympanum from the posterior) in the epitympanum until completely exposed (exposure of the anterior and posterior epitympanum). Cholesteatoma was resected, and all spaces were cleaned. D. Mastoid occlusion was performed with powdered bone, cartilage, muscle, and/or temporal fascia. For reconstruction of the ossicular chain, autologous material or titanium prosthesis was used (PORP or TORP)
Mentions: This paper describes a prospective observational study, using as a sample patients seen at the ear clinic of the Otology and Neuro-Otology service of the University Hospital of Valle in the period between 2009 and 2012. Men and women between 5 and 80 years old diagnosed with cholesteatomatous chronic otomastoiditis who underwent open mastoidectomy with reconstruction in the same surgery were included (Fig. 1A, B, C, D and Fig. 2). Patients for whom surgery was unable to completely remove the cholesteatoma at the first intervention and patients with systemic diseases that contraindicated surgery (according to anesthesiology criteria) were excluded. Postoperative follow-up was conducted at 3, 6 and 12 months, assessing symptoms and findings upon physical examination. Audiometry was tested before surgery, and imaging studies, such as simple scanning (CT) of the middle ear with coronal and axial slices, were conducted. Audiometry was interpreted based on the auditory pure tone average (PTA), which is the average in decibels (dB) at which a patient perceives pure tones at frequencies of 500, 1,000 and 2,000 Hz. Postoperative audiometry was conducted at three months. Statistical analysis of the auditory difference before and after surgery with the paired samples statistic was performed in SPSS. Postoperative MRI ECO-SPIN was requested within a year. The chi-squared test (Χ2) was performed in STATA® 11 to examine the correlation of variables.

Bottom Line: Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up.Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Professor. Specialization in Otology and Neuro-Otology, University of Valle. Cali, Colombia.

ABSTRACT

Introduction: In the surgical management of cholesteatoma, one can opt for a closed technique (simple mastoidectomy) or open surgery (radical mastoidectomy). Open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery combines the advantages of both techniques, namely, adequate surgical exposure, eradication of cholesteatoma, and anatomical reconstruction of the middle ear structures.

Objective: To evaluate the surgical results in the management of cholesteatoma through the technique of open mastoidectomy with reconstruction of the posterior wall and the middle ear in a single surgery.

Methods: Prospective analytical observational study conducted between 2009 and 2012 with patients undergoing this surgical technique in the Hospital Universitario del Valle [University Hospital of Valle], performing preoperative clinical monitoring and quarterly postoperative tomography with previous assessments of hearing and pre- and postoperative audiometry.

Results: Forty-five patients were studied. Mean postoperative follow-up was 28 months. Surgical success was achieved in 93.3% of patients, as measured by clinical and radiological follow-up. Hearing preservation was found after reconstruction of the hearing mechanism, based on measured audiometry, i.e., pure-tone average (PTA), using the statistical test for paired samples between preoperative and postoperative PTA. (95%CI -1.47-12.15). Residual cholesteatoma was present in 6.6% of cases; three to four times lower than the rate reported in the literature.

Conclusions: This type of surgery can be considered a successful technique in the treatment of cholesteatoma in selected cases.

Show MeSH
Related in: MedlinePlus