Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Uluyol, Sinan; Uğur, Ömer; Arslan, İlker Burak; Yagiz, Ozlem; Gümüşsoy, Murat; Çukurova, İbrahim

doi:10.1016/j.bjorl.2017.07.007

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…As previous studies reported outcome on either the obliteration [ 4 , 8 – 10 , 12 – 14 , 16 , 17 ] or the non-obliteration [ 10 – 12 , 15 ] technique alone, it remained unclear whether the outcome of these studies was a result of the surgical technique itself or a result of the surgeons’ skills. As in the present study, the two surgical techniques were performed by the same surgeons in the same institute, we show for the first time that it may actually be the obliteration technique that is robust and an important determinant factor for surgical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…While obliteration techniques in the surgical management of cholesteatoma gain popularity [1], cholesteatoma surgery is still often performed using the traditional canal wall up (CWU) or canal wall down (CWD) approach without obliteration. Although the recurrent and residual cholesteatoma rates after CWD without obliteration are lower compared to CWU without obliteration [2,3], the CWD technique carries several disadvantages caused by the loss of self-cleaning capacity of the ear such as chronical discharge and infection of the persistent mastoid bowl, need for regular maintenance cleaning at the outpatient clinic, caloric-induced dizziness after temperature or pressure changes, the need for precautionary water avoidance measures and difficulty to fit hearing aids [4][5][6][7][8]. Reasons for surgical failure after CWD surgery include residual infected mastoid air cells, large mastoid cavities, high facial ridge, bony overhang in the mastoid cavity, tympanic membrane perforations, narrow meatus and cholesteatoma [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, surgical revision may be necessary to achieve a stable ear. Several surgical techniques have been described in the management of the chronically discharging mastoid cavity, including revision canal wall down mastoidectomy with or without mastoid obliteration and with or without reconstruction of the posterior canal wall [4,[8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

Toom

Schroeff

Molenaar

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction. Methods This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing. Results 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques. Conclusion We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

Toom

Schroeff

Molenaar

et al. 2021

Eur Arch Otorhinolaryngol

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“…Earlier HRQoL surveys in COM-related surgical performances using the GBI reached a 29-100% response rate (Dornhoffer et al 2008, Kurien et al 2013, Bernardeschi et al 2017, Uluyol et al 2017. The response rate in Paper II was 72%, which was equal to that in the study by Robinson et al (Robinson et al 1996).…”

Section: Response Rate and Generalisationmentioning

confidence: 79%

Middle ear cholesteatoma : Surgical outcome and aspects of the innate immunity

Westerberg

2020

Linköping University Medical Dissertations

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Cholesteatomas are bone destructive expansions of keratinizing squamous epithelium in the middle ear and temporal bone. Today, surgery is the only treatment. There are several controversies regarding cholesteatomas, including the definition, the pathogenesis and the surgical method. Intense efforts have been made searching for a comprehension of the cholesteatoma process at a cellular and molecular level. Recurrent infections and inflammation seem to be contributing factors for the cholesteatomas to expand. The innate immunity, essential to keep a healthy middle ear environment and to protect the middle ear from intruding pathogens, is therefore a matter of interest. In this thesis, results are presented from a cohort of cholesteatoma surgeries in Östergötland from a 16-year period. A group of patients also filled in a questionnaire to assess changes in health-related quality of life (HRQoL) after surgery. According to the findings in this thesis, the residual and recurrence frequencies are low, and the hearing and HRQoL are improved in the majority of cases. This thesis also presents an investigation of the innate immunity in ears with acquired cholesteatoma, in comparison to controls with healthy middle ears. The expression of mRNA of toll like receptors 2 and 4, participants of the Janus kinase/signal transducer and activator of transcription pathway, and nitric oxide synthases in middle ear mucosa, were investigated with quantitative polymerase chain reaction. An investigation of nitric oxide (NO) in the middle ear, with chemiluminescence measurements, is also presented. A derangement of the innate immune system is seen in ears with cholesteatoma, which supports the idea that the innate immunity participates in the cholesteatoma process, though the underlying mechanisms are still unclear. The suggestion of NO production in the middle ear sheds light on NOs possible participation in the healthy middle ear environment.

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“…Early detection and conservative approach are important in reducing morbidity associated with such procedures and good hearing rehabilitation. 18…”

Section: Discussionmentioning

confidence: 99%

Cholesteatoma Presentation Trends in Kohat Division

Ayub

Waleem

Afzal

et al. 2021

PAFMJ

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Objective: To discuss the presentation stages of Cholesteatoma in patients of various areas of Kohat division. Study Design: Case series study. Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Nov 2017. Methodology: A total of 60 patients having Chronic Suppurative otitis media with Cholesteatoma were selected from outpatient department. Disease process was evaluated by otomicroscopy as well as radiologically. Perioperative disease spread pattern was also assessed and documented. Results: Out of 28 patients with pars tensa cholesteatoma 28.5% were in stage II and 53.5% were in stage III disease. Out of 32 patients with pars flaccid cholesteatoma, 3.1% presented with stage 1 disease, 37.5% with stage II disease, 50% with stage III disease and 9.3% with stage IV disease. Conclusion: Appropriate measures should be taken for training of general physicians as well as otologists at National level to help early diagnosis and better outcome.

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Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Abstract: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear.

Cited by 16 publications

References 18 publications

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery

Middle ear cholesteatoma : Surgical outcome and aspects of the innate immunity

Cholesteatoma Presentation Trends in Kohat Division

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