Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults

Bernardeschi, Danièle; Russo, Francesca; Nguyen, Yann; Canu, Giuseppina; Mosnier, Isabelle; Seta, Daniele De; Ferrary, Évelyne; Sterkers, Olivier

doi:10.1007/s00405-015-3875-3

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…1). The final 40 studies included a total of 3,116 participants with an average of 76.9 participants per study (Supplemental Table 2, http://links.lww.com/MAO/B542) (11–50). The average age was 36.4 years.…”

Section: Resultsmentioning

confidence: 99%

Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

et al. 2022

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ObjectivesThis review sought to establish expectations for hearing improvement with specifically titanium partial (PORP) and total ossicular replacement prostheses (TORP) to give surgeons an acceptable goal for postoperative hearing results and to counsel patients on their expected results.Databases ReviewedMEDLINE/PubMed, EMBASE, and Cochrane Library.MethodsA systematic review of the literature was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases (MEDLINE/PubMed, EMBASE, Cochrane library) were searched using relevant key search terms to identify studies evaluating outcomes of titanium prostheses. A title/abstract and full article review was then done, and the results from the remaining studies were analyzed with Review Manager 5.4 Software to perform a meta-analysis using a random-effects model.ResultsForty articles were analyzed after full article review based on the inclusion and exclusion criteria. For PORPs, the average improvement in air-bone gap (ABG) and pure-tone average were 12.1 and 13.5 dB, respectively. For TORPs, the average improvements in ABG and pure-tone average were 16.7 and 17.0 dB, respectively. Preoperatively, the average ABG was 7.0 dB better for PORP than TORP patients, and postoperatively, the ABG improved an average of 4.9 dB more for the PORP cohort. Seventy percent of PORPs and 57% of TORPs subjects had a postoperative ABG less than 20 dB.ConclusionsOverall, reconstruction of the ossicular chain with titanium prostheses reliably improves patients' hearing outcomes, and this study gives relevant information for counseling patients preoperatively on realistic hearing outcomes.

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Section: Resultsmentioning

confidence: 99%

Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

et al. 2022

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“…Each reader gave the same scores using EPI and non-EPI in less than 50% of the cases. Moreover, the assessment of EPI DWI showed also very poor agreement between the 2 readers in both pre-and postsurgical cases, which shows that evaluation of EPI DWI by different radiologists brings different results, which is not acceptable in clinical practice [1,3,13].…”

Section: Discussionmentioning

confidence: 95%

“…Typically, cholesteatomas cause osseous erosions along involved structures of the middle ear, and if not treated, it can lead to conductive hearing loss and serious intracranial complications. Due to the potentially erosive and progressive character of middle ear cholesteatomas, the first-choice method of treatment is surgical total excision by canal wall up or wall down tympanomastoidectomy, often with ossicles reconstruction and tympanoplasty [3]. Diagnosis and assessment of the dis-ease extension is based on clinical symptoms, otoscopic findings, and imaging.…”

Section: Introductionmentioning

confidence: 99%

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

Piekarek¹,

Zatoński²,

Kolator³

et al. 2022

Pol J Radiol

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Purpose:The aim of the study was to analyse the value of 2 different diffusion-weighted imaging (DWI) techniques (echo-planar imaging [EPI] and on-echo-planar imaging [non-EPI]) in the diagnosis of cholesteatoma. Material and methods:Our material consisted of 32 subjects suspected of cholesteatoma, who underwent magnetic resonance imaging of the temporal bone using both EPI and non-EPI DWI. Two independent readers retrospectively analysed magnetic resonance images. Intra-and interobserver agreements as well sensitivity, specificity, and negative (NPV) and positive (PPV) predictive values of both DWI sequences were assessed. Results:Using non-EPI DWI all cholesteatomas were correctly diagnosed by both readers with no false negative nor inconclusive cases and with only one false positive result. Non-EPI DWI revealed high interobserver agreement (k = 1) and high correlation with histopathological results (r = 0.895). EPI DWI misdiagnosed 27-31% of cholesteatomas (false negative results), showing also significantly low interobserver agreement (k = 0.373) and low correlation with histopathological results (r = 0.328 for reader 1 and r = 0.267 for reader 2). Non-EPI DWI revealed very high sensitivity (100%), specificity (83.3%), NPV (100%), and PPV (96.3%) in comparison to EPI DWI, which showed lower sensitivity (69.2%), specificity (66.6-83.3%), . Conclusions:Non-EPI DWI with high sensitivity, specificity, and interobserver agreement is a very reliable technique in detecting middle ear cholesteatoma regardless of the pre-or postoperative state of the ear, and it should entirely replace EPI DWI in clinical practice.

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“…Other options have been recommended in the literature. A transcanal atticotomy via a transcanal approach was used to resect epitympanic pathologic tissue [10]. However, that technique has limitations when approaching the tegmen tympani, when using straight instruments.…”

Section: Discussionmentioning

confidence: 99%

Extended Epitympanotomy for Facial Nerve Decompression as a Minimally Invasive Approach

2019

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For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.

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Management of epi- and mesotympanic cholesteatomas by one-stage trans-canal atticotomy in adults

Cited by 8 publications

References 14 publications

Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

Ossicular Chain Reconstruction With Titanium Prostheses: A Systematic Review and Meta-Analysis

The value of different diffusion-weighted magnetic resonance techniques in the diagnosis of middle ear cholesteatoma. Is there still an indication for echo-planar diffusion-weighted imaging?

Extended Epitympanotomy for Facial Nerve Decompression as a Minimally Invasive Approach

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