Management of retraction pockets: historic and novel approaches

Spinos, Dimitrios; Mallick, Sameer; Judd, Owen

doi:10.1017/s0022215121004321

Cited by 3 publications

(2 citation statements)

References 62 publications

(113 reference statements)

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“…Cassano and Cassano 23 utilized the Sadé classification system and Kasbekar et al 27 used the Charachon classification, while the remaining authors did not separate different classifications or did not report classifications at all. Studies have found these staging systems to be poor indicators of management strategy 50,51 with low intra- and inter-rater reliability. 52,53 While the use of a single classification system would be ideal to promote uniformity of assessment, development of a more reliable system is needed before enacting such a change.…”

Section: Discussionmentioning

confidence: 99%

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Gutiérrez

Cabrera

Stout

et al. 2023

Ann Otol Rhinol Laryngol

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Objective: To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. Methods: A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Results: Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Conclusion: Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. Level of Evidence: 3B

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Section: Discussionmentioning

confidence: 99%

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Gutiérrez

Cabrera

Stout

et al. 2023

Ann Otol Rhinol Laryngol

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“…The structure of the TM is important for normal hearing. Many diseases cause hearing loss by altering the TM, such as perforations [3][4][5][6][7], retraction pockets [8][9][10][11], and cholesteatoma [11][12][13]. Other ear diseases cause hearing loss by affecting the middle ear space, which lies directly behind the TM, such as ear infections, middle ear fluid, or tumors of the middle ear.…”

Section: Introductionmentioning

confidence: 99%

Automated Segmentation of Optical Coherence Tomography Images of the Human Tympanic Membrane Using Deep Learning

Oghalai,

Long,

Kim

et al. 2023

Algorithms

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Optical Coherence Tomography (OCT) is a light-based imaging modality that is used widely in the diagnosis and management of eye disease, and it is starting to become used to evaluate for ear disease. However, manual image analysis to interpret the anatomical and pathological findings in the images it provides is complicated and time-consuming. To streamline data analysis and image processing, we applied a machine learning algorithm to identify and segment the key anatomical structure of interest for medical diagnostics, the tympanic membrane. Using 3D volumes of the human tympanic membrane, we used thresholding and contour finding to locate a series of objects. We then applied TensorFlow deep learning algorithms to identify the tympanic membrane within the objects using a convolutional neural network. Finally, we reconstructed the 3D volume to selectively display the tympanic membrane. The algorithm was able to correctly identify the tympanic membrane properly with an accuracy of ~98% while removing most of the artifacts within the images, caused by reflections and signal saturations. Thus, the algorithm significantly improved visualization of the tympanic membrane, which was our primary objective. Machine learning approaches, such as this one, will be critical to allowing OCT medical imaging to become a convenient and viable diagnostic tool within the field of otolaryngology.

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Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

Iannella,

Pace,

Greco

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Atelectasis otitis media (AtOM) is a chronic condition where the tympanic membrane (TM) becomes retracted towards the middle ear and the ossicular chain. Surgical treatment for this condition could be indicated based on stage of atelectasis, patient’s clinical condition and hearing loss. Over the years, AtOM has been treated with various types of tympanoplasty under microscopic view. The aim of this study is to present the results of endoscopic ear surgery in AtOM. Methods Forty-five patients who underwent endoscopic trans-canal tympanoplasty were included in the study. Preoperative features, intraoperative findings and postoperative outcomes were collected. Results Preoperatively, none of the study's patients were classified with a Sadè Grade I, whereas grades II, III and IV were 3 (6.6%), 23 (32.1%) and 19 (67.8%) respectively. The 3 patients with Sadè grade II showed a conductive hearing loss higher than 20 dB and a continuous ear fullness, therefore they were surgically treated. The postoperative graft success rate was estimated at 95.5%. During follow-up, 2 patients showed a TM perforation (at 6 and 12 months after surgery) whereas 1 patient experienced a recurrence of atelectasis in the TM (16 months after surgery). The overall success rate at the final follow-up was calculated at 88.8%. The average preoperative air-conduction threshold was 51.1 ± 21.5, which reduced to 34.6 ± 22.1 (p = 0.04) at follow-up. The preoperative air–bone gap decreased from 28 ± 7.2 to 11.8 ± 10 (p = 0.002) after surgery. Conclusion Atelectasis otitis media might be suitable for exclusive endoscopic surgical treatment, as it appears to exhibit a low recurrence rate and promising audiological outcomes.

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Management of retraction pockets: historic and novel approaches

Cited by 3 publications

References 62 publications

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

Automated Segmentation of Optical Coherence Tomography Images of the Human Tympanic Membrane Using Deep Learning

Endoscopic ear surgery in the treatment of chronic otitis media with atelectasis

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