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Cholesteatoma

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1. Cholesteatoma

Cholesteatoma Cholesteatoma - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cholesteatoma Last reviewed: February 2019 Last updated: January 2018 Summary Accumulation of squamous epithelium and keratin debris that usually involves the middle ear and mastoid. Although benign, it may enlarge and invade adjacent bone. Often presents with a malodorous ear discharge with associated hearing loss. Diagnosis is clinical (...) based on history and otoscopic findings. CT scan provides lesion definition and extent. Treatment is surgical removal. Adjunctive topical antimicrobial treatment may help reduce acute symptoms preoperatively. Complications include recurrence, meningitis, facial palsy, and a labyrinthine fistula. Definition Cholesteatoma is defined as the presence of keratinising squamous epithelium within the middle ear, or in other pneumatised areas of the temporal bone. Fisch U, May JS, Linder T. Mastoidectomy

2018 BMJ Best Practice

3. Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma. (Abstract)

Endaural Laser-Assisted Single-Stage Inside-Out Cholesteatoma Surgery (LASIC) to Treat Advanced Congenital Cholesteatoma. Investigation of endaural laser-assisted single-stage inside-out cholesteatoma surgery (LASIC) to treat advanced congenital cholesteatoma (ACC) by a modified staging system based on ossicle status.A retrospective case review.A university hospital otology referral clinic.Two hundred consecutive pediatric patients with ACC were enrolled.Endaural LASIC and postoperative

2019 Otology and Neurotology

4. Partial Epithelial-Mesenchymal Transition Was Observed Under p63 Expression in Acquired Middle Ear Cholesteatoma and Congenital Cholesteatoma. (Abstract)

Partial Epithelial-Mesenchymal Transition Was Observed Under p63 Expression in Acquired Middle Ear Cholesteatoma and Congenital Cholesteatoma. Partial epithelial-mesenchymal transition (p-EMT) is a process by which epithelial cells partially lose their intercellular adhesion and change to obtain migration ability. The transcription factor p63 regulates the expression of cadherin family and induces epithelial cell proliferation. In this study, we hypothesized that p-EMT under p63 expression may (...) be a key factor in epithelial cell growth in middle ear cholesteatoma.Specimens were surgically excised from patients with congenital cholesteatoma (CC) (n = 48), acquired middle ear cholesteatoma (AC) (n = 120), and normal skin tissue (n = 34). We analyzed immunohistochemically for the EMT marker (N-cadherin), adherence junction marker (E-cadherin), and tight junction marker (claudin-1, claudin-4, occludin). We also examined the labeling index (LI) of p63 and Proliferating cell nuclear antigen (PCNA

2019 Otology and Neurotology

5. The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation. (Abstract)

The Role of Non-Echoplanar Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Primary Cholesteatoma and Cholesteatoma Recidivism as an Adjunct to Clinical Evaluation. The aim of this study was to analyze the sensitivity and specificity of non-echoplanar (non-EPI) diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of cholesteatoma, with a focus on its value as an adjunct to clinical examination.In a prospective cohort study, 92 cases were divided into 2 groups (...) : "clinically cholesteatoma" ( n = 79) and "clinically no cholesteatoma" ( n = 13). Non-EPI DW MRI was performed preoperatively in all cases. The presence of a cholesteatoma was assessed by clinicians otoscopically, by neuroradiologists on non-EPI DW MRI, by the surgeon intraoperatively, and finally by the pathologist postoperatively. Data analysis was performed for specificity, sensitivity, positive predictive value, negative predictive value, and interrater variability.The sensitivity and specificity were

2018 Rhinology and Laryngology

6. Cholesteatoma

Cholesteatoma Cholesteatoma - NICE CKS Share Cholesteatoma: Summary A cholesteatoma is an abnormal sac of keratinizing squamous epithelium and accumulation of keratin within the middle ear or mastoid air cell spaces which can become infected and also erode neighbouring structures. A general practitioner with a list size of 2,500 patients would expect to see, on average, one new case of cholesteatoma every 4–5 years. Cholesteatoma may be asymptomatic in its early stages. Cholesteatoma most (...) commonly presents with a persistent or recurrent discharge from the ear that is often foul smelling. An associated conductive hearing loss may also occur. Rarely with progression of the disease, vertigo, sensorineural hearing loss, facial nerve palsy, meningitis, or intracranial abscess may develop. The diagnosis requires clear visualisation of the tympanic membrane. If the tympanic membrane can be seen, a cholesteatoma should be suspected if there is: Evidence of ear discharge. Presence of a deep

2019 NICE Clinical Knowledge Summaries

7. Analysis of KRT1, KRT10, KRT19, TP53 and MMP9 expression in pediatric and adult cholesteatoma. Full Text available with Trip Pro

Analysis of KRT1, KRT10, KRT19, TP53 and MMP9 expression in pediatric and adult cholesteatoma. Cholesteatoma is an epidermal cyst with still unknown pathomechanism. The aim of the current study was to investigate molecular differences in the background of the hyperproliferative property and aggressive behavior typical of the cholesteatoma epithelium. The expression of three cytokeratin genes (KRT1, KRT10 and KRT19), the matrix metalloproteinase 9 gene (MMP9) and the tumor suppressor TP53 gene (...) was measured by qRT-PCR in surgical samples of pediatric and adult cholesteatoma cases and their expression level was compared to that of normal skin samples from the retroauricular region of control individuals. Cholesteatoma samples were stratified according to the age of onset and recurrence for more detailed analysis. Our results showed identical expression pattern for KRT1 and KRT10, their expression was higher in pediatric cases than in adults, especially in pediatric recurrent samples

2018 PLoS ONE

8. Outpatient management of cholesteatoma with canal wall reconstruction tympanomastoidectomy Full Text available with Trip Pro

Outpatient management of cholesteatoma with canal wall reconstruction tympanomastoidectomy The postoperative wound infection rate for canal wall reconstruction (CWR) tympanomastoidectomy with mastoid obliteration in the treatment of chronic otitis media with cholesteatoma has been reported to be 3.6%. Postoperative administration of 24-48 hours of intravenous antibiotics has been recommended. We aim to determine the infection rate of CWR with postoperative outpatient oral

2017 Laryngoscope investigative otolaryngology

9. Endoscopic transcanal modified canal-wall-down mastoidectomy for cholesteatoma Full Text available with Trip Pro

Endoscopic transcanal modified canal-wall-down mastoidectomy for cholesteatoma Attic cholesteatoma with antral extension in tight sclerotic mastoid cavities is a common presentation that creates difficult decision-making intraoperatively. Drilling through a sclerotic and small mastoid cavity, keeping the canal wall intactis often difficult and increases the risk of serious injury. Consequently, a canal-wall-down mastoidectomy is often performed. The endoscopic transcanal modified canal-wall (...) -down mastoidectomy approach allows the benefits of an open cavity for cholesteatoma resection and the benefits of a closed cavity for better long-term care and a more normal ear canal and middle ear reconstruction.

2017 World journal of otorhinolaryngology - head and neck surgery

10. Negative Predictive Value of Non-Echo-Planar Diffusion Weighted MR Imaging for the Detection of Residual Cholesteatoma Done at 9 Months After Primary Surgery Is not High Enough to Omit Second Look Surgery. (Abstract)

Negative Predictive Value of Non-Echo-Planar Diffusion Weighted MR Imaging for the Detection of Residual Cholesteatoma Done at 9 Months After Primary Surgery Is not High Enough to Omit Second Look Surgery. To evaluate non echo-planar diffusion weighted magnetic resonance imaging (non-EP DW MRI) at 9 months after primary surgery to rule out residual cholesteatoma in patients scheduled before second-look-surgical exploration.Prospective observational study.Secondary teaching hospital.Patients who (...) were scheduled for second-look-surgery after primary canal wall up repair of cholesteatoma underwent 1.5 T MRI including non-EP DWI and high-resolution coronal T1 and T2-FS SE sequences.Imaging studies were evaluated for the presence of cholesteatoma by three independent observers. Intraoperative observations were regarded the standard of reference. Ear, nose, throat (ENT) surgeons were blinded for imaging findings. The primary outcome was the negative predictive value (NPV) of MR imaging

2019 Otology and Neurotology

11. Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases. (Abstract)

Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases. Pre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.A retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been (...) performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.A total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas

2019 Journal of Laryngology & Otology

12. International Collaborative Assessment of the Validity of the EAONO-JOS Cholesteatoma Staging System. (Abstract)

International Collaborative Assessment of the Validity of the EAONO-JOS Cholesteatoma Staging System. Assessment of validity of the Japanese Otological Society and the European Academy of Otology and Neurotology (EAONO-JOS) cholesteatoma staging system (EJS) through international collaboration to investigate: (a) feasibility of retrospectively staging previously acquired data, (b) strengths and weaknesses of the staging system.Nine centers with prospective cholesteatoma databases were recruited (...) . Cases were allocated to EJS Stage at each center using details from time of initial surgery. An independent rater also staged the cases and noted any discrepancies. At one center results from database staging were compared with staging based on contemporaneous operative records. Inter and intrarater reliabilities were calculated, and recidivism rates calculated according to Stage.Of 1482 cases of cholesteatoma, 320 (22%) were Stage 1, 977 (67%) Stage 2, 153 (11%) Stage 3 and 4 (0.3%) Stage 4

2019 Otology and Neurotology

13. Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre. (Abstract)

Growth and Late Detection of Post-Operative Cholesteatoma on Long Term Follow-Up With Diffusion Weighted Magnetic Resonance Imaging (DWI MRI): A Retrospective Analysis From a Single UK Centre. To evaluate the growth rate and late detection of residual cholesteatoma on long-term follow-up with diffusion weighted magnetic resonance imaging (DWI MRI) in clinically stable ears following definitive surgery, in order to define surveillance imaging protocols.Retrospective case review.Tertiary referral (...) center.Patients who underwent DWI MRI at our institution between February 2007 and May 2013 for postoperative cholesteatoma follow-up.Non-echo planar imaging (non-EPI) Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) DWI MRI.Intervals between the definitive surgery and the first and subsequent DWI MRI, the maximum coronal dimension of the lesion on DWI and length of follow-up.The study evaluated 152 postoperative DWI studies performed for 88 patients. In 12 cases, DWI was initially negative

2019 Otology and Neurotology

14. Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma. (Abstract)

Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma. To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM).Retrospective case-control study.Tertiary referral center.One hundred forty mastoidectomies performed (...) in patients under 18 years of age for the treatment of CCOM.Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA.Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications.Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between

2019 Otology and Neurotology

15. The Genetics of Cholesteatoma Study. Loss-of-function variants in an affected family. (Abstract)

The Genetics of Cholesteatoma Study. Loss-of-function variants in an affected family. The aetiology of cholesteatoma remains elusive. In a recent systematic review, we discussed reports of multiple cases of cholesteatoma within families, which suggests a genetic predisposition in some cases (1). We have established a U.K. database and DNA sample bank that can be used to identify genetic variants that co-segregate with cholesteatoma in multiply-affected families. Recruitment to this Genetics (...) of Cholesteatoma (GOC) Study is via the U.K. National Institute of Health Research Clinical Research Network. This preliminary communication describes the results of whole exome sequencing (WES) of DNA extracted from participants in the first fully sequenced family recruited to the study. Rare variants were filtered for co-segregation with the cholesteatoma phenotype, and for their putative functional impact. We have identified loss of function variants in the genes EGFL8 and BTNL9 as candidate variants

2019 Clinical Otolaryngology

16. Perimatrix of middle ear cholesteatoma: A granulation tissue with a specific transcriptomic signature. (Abstract)

Perimatrix of middle ear cholesteatoma: A granulation tissue with a specific transcriptomic signature. To establish comprehensive transcriptomic profiles of cholesteatoma perimatrix tissue and granulation tissue from chronic otitis media (COM) that did not develop cholesteatoma, which can indicate molecular pathways involved in the cholesteatoma perimatrix pathology and invasiveness.Retrospective Case Series.Transcriptome data were obtained from cholesteatoma perimatrix tissue and COM (...) that most significant biological processes involving DEGs were previously described in cholesteatoma pathology. Network analysis identified ERBB2, TFAP2A, and TP63 as major hubs of the DEGs molecular network. Furthermore, it was observed that the cellular component most significantly enriched in DEGs was extracellular space containing 47 DEGs. Using qRT-PCR, it was confirmed that mRNA levels of the major extracellular hub (MMP9) are increased, whereas its interacting molecule (LCN2) mRNA levels were

2019 Laryngoscope

17. Tympanomastoidectomy for Cholesteatoma in Children: Audiometric Results. (Abstract)

Tympanomastoidectomy for Cholesteatoma in Children: Audiometric Results. The aim of this study was to investigate the audiometric outcomes of tympanomastoidectomy in children with cholesteatoma and to evaluate factors that may affect outcomes.A retrospective cohort study was conducted. All pediatric patients diagnosed with cholesteatoma who underwent primary canal wall-up tympanomastoidectomy with or without ossicular reconstruction from 2009 to 2016 at a tertiary university-affiliated (...) to the preoperative value (28.1 ± 14.7 dB) at both the first (19.1 ± 11.9 dB, P = .006) and last (22.4 ± 15.1 dB, P = .011) audiometry examinations.Hearing outcomes after pediatric cholesteatoma surgery are diverse and related to several factors. The authors found that ossicular reconstruction improves audiometric outcomes, and the changes remain stable over time.IIB.

2019 Rhinology and Laryngology

18. Value of DW-MRI in the preoperative evaluation of congenital cholesteatoma. (Abstract)

Value of DW-MRI in the preoperative evaluation of congenital cholesteatoma. This study evaluated the clinical value of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis and staging of congenital cholesteatoma (CC).We retrospectively reviewed 24 patients with CC. All the patients underwent computed tomography (CT) and DW-MRI preoperatively; thereafter, surgery was performed. DW-MRI examination was performed with a 3 T MRI system using three-dimensional reversed fast imaging (...) with steady-state precession and diffusion-weighted magnetic resonance sequence. The preoperative and operative CT and DW-MRI findings were compared.Using DW-MRI, cholesteatoma was successfully detected in 17 (71%) of the 24 patients with CC. Among the seven patients with false-negative results, the cholesteatoma mass diameter was <5 mm in six patients and ≥5 mm in one patient. One of these patients had open type congenital cholesteatoma (OTCC). The detection rates for closed type cholesteatoma and OTCC

2019 International Journal of Pediatric Otorhinolaryngology

19. Treatment using diffuse laser energy of cochlear and vestibular fistulas caused by cholesteatoma. (Abstract)

Treatment using diffuse laser energy of cochlear and vestibular fistulas caused by cholesteatoma. To measure the outcomes of laser treatment of cholesteatoma covering cochlear and vestibular fistulas.Cholesteatoma matrix over the fistula was denatured; the power density was sufficient only to gradually heat, but not vaporise, the keratin-forming matrix. The denaturing speed was controlled so that the integrity of the fistula cover was maintained. The change in bone conduction threshold (...) and the residual rate of cholesteatoma at the fistula were measured.Thirty-six fistulas were assessed. There were seven cochlear fistulas. All were 5 mm or less in maximum length. For the entire group, the average change in bone conduction threshold was -0.3 dB. For cochlear fistulas, the average change in bone conduction was + 0.2 dB. The distribution of hearing results for the entire group was Gaussian; the apparent changes in hearing could be attributed to errors associated with testing. All patients

2019 Journal of Laryngology & Otology

20. The Antrum-Malleus-Tegmen Score: A Pilot Study Assessing Preoperative Radiographic Predictors for Transcanal Endoscopic Cholesteatoma Dissection. (Abstract)

The Antrum-Malleus-Tegmen Score: A Pilot Study Assessing Preoperative Radiographic Predictors for Transcanal Endoscopic Cholesteatoma Dissection. Identify features on computed tomography (CT) that predict mastoidectomy conversion (MC) during transcanal endoscopic ear surgery (TEES).Retrospective case-control.University otology practice.Consecutive patients with cholesteatoma.TEES cholesteatoma dissection versus those requiring MC.Antrum opacification, depth of scutum involvement, and erosion (...) of the mastoid trabeculae, ossicular chain, and tegmen were evaluated. Univariable and multivariable regression analysis was performed. The Antrum-Malleus-Tegmen (AMT) score was created using receiver operating characteristic curves to assess feasibility of performing TEES for cholesteatoma dissection.There were 39 TEES and 19 MC cases. Groups had similar age (median 28.5 yr), gender, laterality, and revision surgery status. Median surgical time for MC cases was longer than TEES (231 min vs. 171 min, p

2019 Otology and Neurotology

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