Blind sac closure: a safe and effective management option for the chronically discharging ear

Muzaffar, Jameel; Dawes, Stephanie S.; Nassimizadeh, Abdul; Coulson, Chris; Irving, Richard

doi:10.1111/coa.12634

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…The potential consequences of a closed cavity in the setting of cholesteatoma, infection, and mucosal disease are noteworthy. On the surface, canal closure is sensible in this situation: chronic drainage can negatively affect quality of life, social functioning, and perceptions of general and mental health, 14 and closure of the ear canal, if successful, should technically stop ear drainage. In fact, the original description of the Rambo ear canal closure was directed toward chronically draining ears in which “the advantage of good temporal bone surgery is often lost because the ear continues to drain.” 1 That being said, it has been shown that patients with chronic mucosal disease have a higher postoperative complication rate following ear canal closure 3 .…”

Section: Discussionmentioning

confidence: 99%

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients

You

Lovin

Patel

et al. 2022

Otolaryngol.--head neck surg.

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Objective To present the surgical and quality of life (QOL) outcomes of patients who underwent blind sac closure of the external auditory canal (EAC) via a modified Rambo approach. Study Design Retrospective case review. Setting Tertiary academic referral center. Methods All patients who underwent EAC closure with a modified Rambo approach between 2015 and 2021 were evaluated. Complication rates, QOL estimations from a validated survey, and subjective cosmetic reports were analyzed. Results Thirty-five ears were closed in 31 patients. The most common indication for surgery was related to cochlear implantation and cochlear malformation or cholesteatoma (31.4%). No case involved an immediate complication requiring revision surgery, and 4 ears (11.4%) were suspected of having cholesteatoma within the surgical cavity at a mean 28.6-month follow-up. Adults (≥18 years) had significantly higher QOL scores than children in the medical resource subscale of the Chronic Ear Survey ( P < .01), and patients undergoing concurrent EAC closure and skull base tumor removal scored higher than others ( P = .04). Females reported higher cosmetic scores than males ( P = .04). QOL and cosmetic scores compared favorably to previously published data involving the management of otologic disease. Conclusions Ear canal closure can be a useful technique for select adult and pediatric patients. Patient and surgeon concerns regarding QOL and cosmesis in ear canal closure should be explored prior to employing this surgical technique, though the present data suggest that the modified Rambo approach to closure is generally associated with reasonable outcomes in both areas.

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Section: Discussionmentioning

confidence: 99%

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients

You

Lovin

Patel

et al. 2022

Otolaryngol.--head neck surg.

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“…If disease can be effectively cleared, blind sac closure offers the advantage of a completely dry ear while avoiding the creation of a large cavity that requires routine cleaning and maintenance. 25…”

Section: Discussionmentioning

confidence: 99%

The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology

Casazza

Carlson

Shelton

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base. Study Design: Retrospective case series Setting: Two tertiary care academic centers. Patients: Patients surgically managed for medially-invasive cholesteatoma at two tertiary care institutions from 2001 to 2017. Interventions: Surgical management of medially-invasive cholesteatomas. Main Outcome Measures: The presenting symptoms, imaging, pre- and post-operative clinical course, and complications were reviewed. Results: Seven patients were identified. All patients had pre-operative radiographic evidence of invasive cholesteatoma with erosion into the otic capsule beyond just a lateral semicircular canal fistula. Five patients had a complex otologic history with multiple surgeries for recurrent cholesteatoma including three with prior canal wall down mastoidectomy surgeries. Average age at the time of surgery was 41.3 years (range 20-83). Two patients underwent a hearing preservation approach to the skull base while all others underwent a surgical approach based on the extent of the lesion. Facial nerve function was maintained at the pre-operative level in all but one patient. No patient developed cholesteatoma recurrence. Conclusions: The medially-invasive cholesteatoma demonstrates an aggressive, endophytic growth pattern, invading into the otic capsule or through the perilabyrinthine air cells to the petrous apex. Surgical resection remains the best treatment option for medially-invasive cholesteatoma. When CSF leak is a concern, a subtotal petrosectomy with closure of the ear is often necessary.

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“…Gainera, ebakuntza egiteko garaian, pazienteen % 60k entzumenaren narriadura zeukan (transmisiozko hipoakusia, hipoakusia neurosentsorial edo hipoakusia misto moduan) eta % 25,7 zuzenean kofosiarekin joan zen interbentzioa egitera. Oro har, aztertutako serieetan ebakuntza aurreko egoera audiologikoa antzekoa izan da, hipoakusia larri sakona pazienteen % 46-% 100ek aurkezten zuen (4,16) eta kofosia pazienteen % 39-60 artean (11,12,17). PSTaegitearekin 50-60 dB-erainoko transmisiozko hipoakusia eragiten zaie pazienteei (7).…”

Section: Konplikazioakunclassified

“…Errezidibaren diagnostikoa irudi bidez egin zen bi kasuetan, eta hirugarrengoan klinika gailendu zen. Serie ezberdinetako errezidibaren portzentajeak oso aldakorrak direla ikusi da, % 1,1 izatetik % 3,8, % 6, edo % 19 izatera hel daitezkeelako (4,17,19,20). Belarri atzeko fistula pazienteen % 5,7an deskribatu da DUOn, kasu guztietan konplikazio berantiarra izan zen eta denek behar izan zuten ebazpen kirurgikoa arazoa konpontzeko (paziente batek bi aldiz behar izan zuen ebakuntza fistularen itxiera lortzeko).…”

Section: Konplikazioakunclassified

Petrosektomia subtotala kolesteatomaren tratamendurako: 2008-2018 arteko ikerketa erretrospektiboa duo-n

Burgo¹

2021

Osag

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Kolesteatoma jatorri ezberdineko erdiko belarrian hazten den epitelio ezkatatsu keratinizatuaren bilduma da, tamaina eta kokapenaren arabera klinika zabala eman dezakeena. Kolesteatomaren tratamendua kirurgikoa da, eta tinpanoplastia edota mastoidektomia dira aukerako teknikak. Zenbaitetan, ordea, aukera inbasiboagoetara jo behar da, eta horrelakoetan petrosektomia subtotala (PST) aukera baliagarria bilaka daiteke. Lan honetan Donostia Unibertsitate Ospitalean (DUOn) 2008-2018 artean erdik obelarriko otitis kronikoaren edota kolesteatomaren tratamendurako egindako petrosektomia subtotalen emaitzak erretrospektiboki aztertu eta literaturan aurkitu diren emaitzekin alderatuko dira. DUOko Otorrinolaringologia Sailean 2008-2018 artean egin ziren PSTen datuak bildu eta indikazioa erdiko otitis kronikoa edota kolesteatoma ziren kasuak aztertu dira, parámetro ezberdinak ikertuz. Bestalde, PubMed datubasean PSTaren inguruko bilaketa bibliografikoa egin da eta DUOko emaitzak PubMed-en aurkitutakoekin alderatu dira. 2008-2018 artean 73 PST egin ziren, indikazio ohikoenak erdiko belarriko otitis kronikoa (% 31), kolesteatomaren errezidiba (% 25) eta prozesu tumoralak (% 29) izanik. PST guztietatik, 35ek izan zuten erdiko otitis kronikoa edota kolesteatoma indikazio gisa. Ospitaleko batez besteko egonaldia 5,74 egunekoa izan zen. Kirurgia ostean batez besteko jarraipen-denbora 3,45 urte izan zen, eta kontrolerako EMNa erabili zen kasuen % 48,6an. Maizen agertu ziren konplikazioak honakoak izan ziren: infekzioa, paralisifaziala, hipofuntzio bestibularra, odoljarioa, belarriko fistula eta kolesteatomaren errezidiba. Oro har, DUOko egoera literaturan aurkitutako egoeraren parekoa da indikazioen, kirurgiaaurreko egoeraren, paziente motaren eta egoera audiologikoaren ikuspuntutik. Konplikazioei dagokienez, antzeko portzentajean agertu dira, baina infekzio-tasa handiagoa aurkitu da DUOko seriean, eta, horregatik, ikerketa sakonago bat egin liteke.

show abstract

Blind sac closure: a safe and effective management option for the chronically discharging ear

Cited by 9 publications

References 12 publications

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients

Quality of Life After Modified Rambo Ear Canal Closure in Pediatric and Adult Patients

The Medially-Invasive Cholesteatoma: An Aggressive Subtype of a Common Pathology

Petrosektomia subtotala kolesteatomaren tratamendurako: 2008-2018 arteko ikerketa erretrospektiboa duo-n

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