Mastoid cavity obliteration using bone pâté versus bioactive glass granules in the management of chronic otitis media (squamous disease): a prospective comparative study

Mishra, Awadhesh Kumar; Mallick, Ajay; Galagali, J. R.; Gupta, Amit; Sethi, Ashwani; Ghotra, A

doi:10.1017/s0022215121001195

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…We included bone replacement materials such as hydroxyapatite granulate or bioglass because these materials behave consistently like bone paté. 51 The result of this analysis did not assume differences in material, but we cannot make further conclusions without randomized controlled trials and a larger sample size.…”

Section: Random Effects Modelmentioning

confidence: 86%

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Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

et al. 2022

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Objective: Our study aims to evaluate the effectiveness of mastoid obliteration compared to the canal wall up (CWU) technique in cholesteatoma surgery based on the systematic review of the literature and the meta-analysis of the data.Methods: The systematic search was performed in four major databases (MEDLINE, Web of Science, Embase, and CENTRAL) on October 14, 2021. Studies comparing the CWU technique and mastoid obliteration were included. The exclusion criteria were less than 12 months follow-up, congenital cholesteatoma, indefinite description of the surgical method, and animal studies. The protocol was registered on Prospero (registration number: CRD42021282485). The risk of bias was evaluated with the ROBINS-I tool. Residual and recurrent disease proportions as primary outcomes, quality of life, ear discharge, infection rates, hearing results, and operation time as secondary outcomes were analyzed. In the quantitative synthesis, the random effect model was used, and heterogeneity was identified.Results: A total of 11 articles with 2077 operations' data were found eligible. All the identified studies were retrospective cohorts. The odds of pooled residual and recurrent disease proportion were significantly lower in the obliteration group compared to CWU (OR = 0.45, CI:0.28;0.80, p = 0.014). However, when separated, the proportion of ears with recurrent (OR = 0.41, CI:0.11;1.57, p = 0.140) or residual (OR = 0.59, CI:0.23, 1.50, p = 0.207) disease did not show a significant difference, even though the odds were quite similar. The qualitative synthesis identified no significant difference in the secondary outcomes, but obliteration elongated the operation time.Conclusion: Mastoid obliteration significantly decreased the proportion of residual and recurrent cholesteatoma in pooled analyses compared to the CWU technique with low-quality of data.

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Section: Random Effects Modelmentioning

confidence: 86%

“…For this reason, we decided to do a subgroup analysis on studies that used autologous bone dust or bone replacement material. We included bone replacement materials such as hydroxyapatite granulate or bioglass because these materials behave consistently like bone paté 51 …”

Section: Discussionmentioning

confidence: 99%

Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

et al. 2022

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“…A review of synthetic materials by Skoulakis et al ( 20 ) deemed BAG the most reliable material. A recent study by Mishra et al ( 21 ), comparing bone pâté to BAG, showed no significant differences in recidivism or complications. Long-term outcomes in a small cohort showed that obliteration with hydroxyapatite resulted in high rates of revision surgery and recidivism ( 22 ).…”

Section: Discussionmentioning

confidence: 88%

Mastoid Obliteration Using S53P4 Bioactive Glass in Cholesteatoma Surgery: A 10-Year Single-Center Experience in 173 Adult Patients with Long-Term Magnetic Resonance Imaging Controlled Follow-up

Kroon

Mes²,

Borggreven³

et al. 2022

Otol Neurotol

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Objective: To present the long-term outcomes of mastoid obliteration in cholesteatoma surgery using S53P4 bioactive glass (BAG) in an adult population. Study Design: Retrospective cohort study. Setting: Single-center study. Patients: All 173 adult patients who underwent primary or revision surgery for cholesteatoma with mastoid obliteration using S53P4 BAG with at least 1 year of follow-up including nonecho planar diffusion-weighted magnetic resonance imaging (MRI) (non-EP DWI MRI) and/or second-look surgery to evaluate recidivism. Both canal wall up (CWU) and canal wall down (CWD) procedures were included. Intervention(s): Patients underwent CWU or CWD mastoidectomy using S53P4 BAG. Main Outcome and Measures: Cholesteatoma recidivism, postoperative complications, Merchant grade, hearing outcome. Results: Cholesteatoma recidivism was assessed by MRI in 97% of all cases and second-look surgery look surgery in 3% of cases.After a mean follow-up period of 53 months, cholesteatoma recidivism was seen in 10% of the cases (n = 18). Using the Kaplan-Meier curve to extrapolate, a 5-year recidivism rate of 12% was estimated. Only minor complications occurred, all resolving spontaneously or after minor treatment. Merchant grade of 0 to 1 was achieved 95% of the patients, no persistently wet ears were observed. Closure of the air-bone gap within 20 dB was possible in 32%. Conclusion:In this long-term (up to 10 yr) follow-up study, we demonstrated the safety of S53P4 BAG. Minimal and only minor postoperative complications were observed. The effectiveness of BAG was indicated by the low rate of recidivism, even when using non-EP DWI MRI, a sensitive and specific noninvasive technique to detect cholesteatoma recidivism.

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“…Several studies reported on SSI after mastoid obliteration with BAG S53P4 in the management of chronic otitis media with and without cholesteatoma ( Bernardeschi, 2015 ; de Veij Mestdagh, 2017 ; Król, 2021 ; Leonard, 2021 ; Mishra, 2021 ; Sarin, 2012 ; Schimanski, 2015 ; Silvola, 2012 ; Sorour, 2018 ; Stoor, 2010 ; Vos, 2017 ) (see supplementary information, Table S2 ). The SSI rates in these studies vary from 0 to 2% and are lower compared to our rate of 12%, except for Silvola et al.…”

Section: Discussionmentioning

confidence: 99%

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

et al. 2022

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Introduction This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication, i.e. postoperative surgical site infection (SSI) in cases with and without mastoid obliteration. Materials and methods Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019. Patient characteristics, peri- and postoperative management and complications were reviewed. The cases were divided into two groups based on whether mastoid obliteration was performed or not. Results A total of 336 cholesteatoma operations were performed, of which 248 cases received mastoid obliteration. In total 21 complications were observed, of which SSI was the most common (15/21). No difference in occurrence of any postoperative complication was seen between the obliteration and no-obliteration group ( p = 0.798), especially not in the number of SSI ( p = 0.520). Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups. In the no-obliteration group a younger age (p = 0.015), as well as primary surgery ( p = 0.022) increased the risk for SSI. In the obliteration group the use of bioactive glass (BAG) S53P4 was identified as independent predictor of SSI ( p = 0.008, OR 5.940). Discussion SSI is the most common postoperative complication in cholesteatoma surgery. The causes of SSI are multifactorial, therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.

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Mastoid cavity obliteration using bone pâté versus bioactive glass granules in the management of chronic otitis media (squamous disease): a prospective comparative study

Cited by 7 publications

References 28 publications

Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

Mastoid Obliteration Decreases the Recurrent and Residual Disease: Systematic Review and Meta‐analysis

Mastoid Obliteration Using S53P4 Bioactive Glass in Cholesteatoma Surgery: A 10-Year Single-Center Experience in 173 Adult Patients with Long-Term Magnetic Resonance Imaging Controlled Follow-up

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

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