Cholesteatoma Recidivism

Neudert, Marcus; Lailach, Susen; Lasurashvili, Nikoloz; Kemper, M; Beleites, Thomas; Zahnert, Thomas

doi:10.1097/mao.0000000000000484

Cited by 38 publications

(20 citation statements)

References 32 publications

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“…1 In the four studies presented here, 1,250 patients were treated with CWU procedures and 49 (3.9%) unexpected residual cholesteatomas were found. [1][2][3][4] Four hundred seventy-eight planned secondlook procedures were performed and 156 (32.6%) residual cholesteatomas were found. Therefore, more than 67% of the second-look procedures were unnecessary.…”

Section: Discussionmentioning

confidence: 72%

“…Neudert et al evaluated 406 procedures comparing tympanoplasty with endoscopic evaluation (45 procedures), CWU mastoidectomy (321 procedures), and CWD mastoidectomy with or without obliteration of the mastoid bowl (40 procedures). 1 They used an algorithm to determine the extent of the surgery. Patients in whom the canal was intact preoperatively underwent tympanoplasty with endoscopic evaluation or canal wall up tympanomastoidectomy.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The total recidivism rate has been found in various studies to be between 10% and 70%. 1 The primary treatment has been debated for decades, with recommendations for canal wall down (CWD), canal wall up (CWU), staged procedures, and endoscopic procedures. Historically, CWD procedures have lower overall recidivistic rates.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, some have advocated foregoing the second look in favor of a planned single-stage procedure with CWD procedures for those with known extensive disease, and CWU procedures for those whom the cholesteatoma can be removed completely. 1 The reasoning is that only residual disease is addressed by second-look procedures; if the disease is entirely removed in the primary procedure, second-stage procedures should not be necessary. To minimize any unnecessary procedures, some surgeons recommend two-stage procedures only when cholesteatoma persistence is uncertain.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cholesteatoma: Is a second stage necessary?

Keeler

Kaylie

2016

The Laryngoscope

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Section: Discussionmentioning

confidence: 72%

Section: Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cholesteatoma: Is a second stage necessary?

Keeler

Kaylie

2016

The Laryngoscope

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“…This surgery is required to inspect the ME and determine whether the cholesteatoma has recurred. Recurrence happens only about 25% of the time, meaning that many patients have a second surgery, but do not have recurrence [11], [12], [13]. The non-invasive approach through the Eustachian tube that we propose in this paper could save these patients a second surgery, and more broadly help physicians diagnose and treat a variety of ME diseases less invasively.…”

Section: Introductionmentioning

confidence: 99%

Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into the Middle Ear

Fichera

Dillon

Zhang

et al. 2017

IEEE Robot. Autom. Lett.

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This paper presents a novel miniature robotic endoscope that is small enough to pass through the Eustachian tube and provide visualization of the middle ear (ME). The device features a miniature bending tip previously conceived of as a small-scale robotic wrist that has been adapted to carry and aim a small chip-tip camera and fiber optic light sources. The motivation for trans-Eustachian tube ME inspection is to provide a natural-orifice-based route to the ME that does not require cutting or lifting the eardrum, as is currently required. In this paper, we first perform an analysis of the ME anatomy and use a computational design optimization platform to derive the kinematic requirements for endoscopic inspection of the ME through the Eustachian tube. Based on these requirements, we fabricate the proposed device and use it to demonstrate the feasibility of ME inspection in an anthropomorphic model, i.e. a 3D-printed ME phantom generated from patient image data. We show that our prototype provides > 74% visibility coverage of the sinus tympani, a region of the ME crucial for diagnosis, compared to an average of only 6.9% using a straight, non-articulated endoscope through the Eustachian Tube.

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Subtotal Petrosectomy and Cochlear Implantation

Yan

Reddy

Isaac

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Subtotal petrosectomy (STP) has been more frequently performed to prepare ears with unfavorable conditions for cochlear implantation.OBJECTIVES To provide an overview of indications for and complications of STP and cochlear implantation and to compare outcomes between single vs multistage procedures and between pediatric vs adult populations.DATA SOURCES A search of PubMed, Scopus, Ovid, and the Cochrane Library was performed from the databases' inception to January 23, 2020, for studies evaluating STP for cochlear implantation.STUDY SELECTION Studies with a minimum follow-up of 3 months and no missing data regarding postoperative outcomes were included. Of the initial 570 studies identified, 27 (4.7%) met selection criteria. DATA EXTRACTION AND SYNTHESISTwo reviewers independently assessed study eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines; discrepancies were resolved by a third reviewer. Extracted data included patient demographics, indications for STP, rates of complications, and cholesteatoma recidivism when applicable. Data were pooled using a random-or a fixed-effects model when appropriate. MAIN OUTCOMES AND MEASURESThe primary study outcome was rate of global complications stratified by patient-and surgery-level characteristics. RESULTSTwenty-seven unique studies with 377 unique patients (54.2% male; mean age, 50.6 [range, 1-99] years) undergoing 397 STP procedures and cochlear implantation were included. Of these procedures, 299 of 394 cases with the information reported (75.9%) were single procedures and 95 (24.1%) were multistage procedures. Of the total 397 STP procedures, most common indications included chronic otitis media (220 cases [55.4%]), previous open mastoid cavity (141 [35.5%]), cholesteatoma (74 [18.6%]), and cochlear ossification (29 [7.3%]). The overall complication rate was 12.4% (95% CI, 9.4%-15.9%); overall cholesteatoma recidivism rate was 9.3% (95% CI, 4.3%-17.1%). Complication rates did not significantly differ based on stage or age of patients. Cases with cholesteatoma more often underwent multistage vs single-stage procedures (23 of 54 [42.6%] vs 35 of 174 [20.1%]).CONCLUSIONS AND RELEVANCE Across all age groups, STP has been shown to be an effective surgical operation in preparing an ear with unfavorable conditions for cochlear implantation. The potential indications for which cochlear implantation can be performed have expanded with the use of STP. Presence of cholesteatoma might indicate that a multistage procedure should be performed. Lastly, with complication rates comparable to those in adult patients, STP can be considered in children requiring cochlear implantation to minimize ear-related issues and allow benefit from cochlear implantation.

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Cholesteatoma Recidivism

Cited by 38 publications

References 32 publications

Cholesteatoma: Is a second stage necessary?

Cholesteatoma: Is a second stage necessary?

Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into the Middle Ear

Subtotal Petrosectomy and Cochlear Implantation

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