Intraoperative Bleeding and the Risk of Residual Cholesteatoma: A Multivariate Analysis

Nobel, Gavin J. le; Cushing, Sharon L.; Papsin, Blake C.; James, Adrian

doi:10.1097/mao.0000000000001355

Cited by 22 publications

(14 citation statements)

References 25 publications

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“…On the other hand, the hereby investigated model lacks bleeding, which is of course an important issue in the operating room. The one-handed surgical technique in EES requires decent knowledge and skills in managing the bleeding [18, 19], which are different from the microscopic technique and may impede with the learning curve during clinical application. However, it is important to stress, that technical as well as procedural differences should not be confounded with learning curves for young surgeons.…”

Section: Discussionmentioning

confidence: 99%

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

et al. 2019

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Background Endoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures (errors) in surgeons with different training levels. Methods Final-year medical students (n = 9), residents (n = 14) and consultants (n = 10) from the Department of Otorhinolaryngology, Head and Neck Surgery at the University Hospital of Bern, Switzerland were enrolled in the present study. After randomization every participant had to complete a standard set of grasping and dissecting surgical tasks in a temporal bone model. After the first session the participants were crossed over to the other technique. Results Time required for completion of the surgical tasks was similar for both techniques, but highly dependent on the training status. A significant increase in the number of damages to the ossicular chain was observed with the microscopic as compared to the endoscopic technique (p < 0.001). Moreover, students beginning with the endoscopic technique showed an overall significantly lower amount of time to complete the tasks (p = 0.04). From the subjective feedback a preference towards the endoscopic technique mainly in medical students was observed. Conclusions The endoscopic approach is useful and beneficial for teaching basic surgical skills, mainly by providing a reduction of damage to surrounding tissues with similar operating times for both techniques. Moreover, medical students performed significantly faster, when first taught in the endoscopic technique. Especially for young surgeons without previous training in ear surgery, the endoscope should be considered to improve surgical skills in the middle ear.

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Section: Discussionmentioning

confidence: 99%

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

et al. 2019

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“…11 This especially holds true for single-handed endoscopic surgery, which may put critical structures at risk and also increase the chance of leaving behind residual disease. 12 However, with a good local infiltration, intraoperative use of adrenaline-soaked cotton balls and appropriate suction instruments, a clear working field can be achieved in most cases.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

et al. 2019

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Objectives To compare endoscopic transcanal approach to attic cholesteatoma with conventional microscopic transcanal technique Methods Seventy‐eight patients diagnosed with attic cholesteatoma were randomly assigned into two groups—one undergoing endoscopic approach and the other microscopic technique. The two groups were compared in terms of area of exposure, access to hidden areas in terms of Middle Ear Structural Visibility Index (MESVI), intraoperative time, postoperative pain, vertigo, long‐term hearing, and surgical outcomes. Results The mean area of exposure in endoscopic atticotomy required was less than that in microscopic group and was found to be statistically significant. The median MESVI for endoscopic group better than that for microscopic group (P < .0001). The mean operating time in endoscopic approach was less than that in case of microscopic approach, with P < .05. The median postoperative pain score in the endoscopic group was less than that in microscopic group (P < .05). No significant difference was found between two groups in terms of vertigo experienced at the end of first week and air‐bone gap closure. When long‐term surgical outcomes were assessed at 1 year, in endoscopic group, one patient had disease recurrence, one cartilage displacement, one perforation, and two had retraction pocket formation. In the microscopic group, two patients had recurrence, four cartilage displacement, one perforation, and five retraction pocket formation. Conclusion Endoscopic management of limited attic cholesteatoma has definite advantages over the conventional microscopic approach. Level of Evidence 1 Laryngoscope, 130:2461–2466, 2020

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“…The figures of residual disease detected in our study concur with those by figures reported by other workers, namely El Meselaty, 7 Presutti, 8 Ayubi, 9 Ayache, 10 Elfeky, 11 le Nobel. 13 Our study had a few limitations. Firstly, it was a relatively small study sample of 42 patients.…”

Section: Discussionmentioning

confidence: 94%

In Saving the Canal Wall, can MERI and Otoendoscopes Help Take a Call?

Kar

Mukherjee

Sanyal

et al. 2021

BJOHNS

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Introduction The study was aimed to find out whether any correlation exists between Middle Ear Risk Index (MERI) and the diagnostic ability of otoendoscopes to help in the decision making to preserve the posterior canal wall in management of cases of chronic otitis media(COM) squamous type. Materials and Methods Patients of chronic otitis media squamous active type were subjected to tympanomastoid surgery under the microscope and adjunctive use of otoendoscope. After proper disease clearance under microscope, otoendoscopes were taken as an adjunct to find out whether any residual disease was being left behind and to confirm whether the posterior canal wall could be preserved. Dubious cases in which the canal wall could be saved due to conclusive evidence of disease removal through the endoscope were taken as the ones being influenced by otoendoscopic decision-making. Results Patients having moderate MERI score were likely to have their canal walls spared by endoscopic evaluation. Discussion The percentage of residual disease detected with otoendoscopes were concurrent with other studies reporting similar figures. Conclusion The otoendoscope is decidedly more helpful in conclusive decision making in preserving the posterior canal wall in a case of chronic otitis media.

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Intraoperative Bleeding and the Risk of Residual Cholesteatoma: A Multivariate Analysis

Cited by 22 publications

References 25 publications

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques

Endoscopic Versus Microscopic Management of Attic Cholesteatoma: A Randomized Controlled Trial

In Saving the Canal Wall, can MERI and Otoendoscopes Help Take a Call?

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