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Cholesteatoma

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141. Combined Surgical Approach to Giant Cholesteatoma: A Case Report and Literature Review. (PubMed)

Combined Surgical Approach to Giant Cholesteatoma: A Case Report and Literature Review. Cholesteatomas can grow to a remarkable size before clinically making their presence felt. Managing giant cholesteatomas and their complications can become a challenge for the otological surgeon.We describe a case of a giant congenital cholesteatoma of the mastoid in an adult. The lesion extended to the sigmoid sinus, jugular bulb, carotid canal, occipital condyle, and the lateral portion of the first (...) cervical vertebra. Surgical excision was performed using a combined microscopic and endoscopic surgical approach.Our combined surgical technique enabled a more accurate removal of the cholesteatoma than a microscopic approach alone, with no surgical complications or damage to the structures affected by the disease.Using endoscopic instruments to manage giant cholesteatomas can help to avoid complications and improve surgical radicality.© The Author(s) 2016.

2016 Rhinology and Laryngology

142. Gustatory Dysfunction and Decreased Number of Fungiform Taste Buds in Patients With Chronic Otitis Media With Cholesteatoma. (PubMed)

Gustatory Dysfunction and Decreased Number of Fungiform Taste Buds in Patients With Chronic Otitis Media With Cholesteatoma. To compare the number of fungiform taste buds among patients with chronic otitis media (COM), those with pars flaccida retraction type cholesteatoma, and those with pars tensa retraction type cholesteatoma in combination with gustatory function.Thirty-seven patients with COM, 22 patients with pars flaccida retraction type cholesteatoma, and 17 patients with pars tensa (...) retraction type cholesteatoma were included. An average of 10 fungiform papillae (FP) per patient in the midlateral region of the tongue were observed by confocal laser scanning microscopy in vivo, and the average number of taste buds were counted. Just before the observation of FP, electrogustometry (EGM) was performed to evaluate gustatory function.A significant decrease of the average number of fungiform taste buds and significant elevation of EGM thresholds were clarified in the pars tensa retraction

2016 Rhinology and Laryngology

143. Cholesteatoma in the Sellar Region Presenting as Hypopituitarism and Diabetes Insipidus. (PubMed)

Cholesteatoma in the Sellar Region Presenting as Hypopituitarism and Diabetes Insipidus. Clinically significant sellar cysts unrelated to pituitary adenomas are uncommon. Intracranial cholesteatomas are also rare and are most common in the middle ear and mastoid region. We report an even rarer case of cholesteatoma in the sellar region-a challenging diagnosis guided by clinical presentations, radiological signs, and biopsy, aiming at emphasize the importance of considering cholesteatoma when (...) making differential diagnoses of sellar lesions.We present a case of cholesteatoma in the sellar region in a 56-year-old man with hypopituitarism, diabetes insipidus, and cystic imaging findings. It was difficult to make an accurate diagnosis before surgery. We present detailed analysis of the patient's disease course and review pertinent literature.The patient underwent a surgical exploration and tumor resection through a transsphenoidal approach. Pathologic results revealed a cholesteatoma

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2016 Medicine

144. Repeated Postoperative Follow-up Diffusion-Weighted Magnetic Resonance Imaging to Detect Residual or Recurrent Cholesteatoma. (PubMed)

Repeated Postoperative Follow-up Diffusion-Weighted Magnetic Resonance Imaging to Detect Residual or Recurrent Cholesteatoma. In our institution, follow-up diffusion-weighted imaging (DWI) after cholesteatoma surgery is performed at least twice. The aim of this study was to determine the yield of the second follow-up DWI (D-W MRI-2) in patients in whom the first postoperative DWI (D-W MRI-1) was negative for residual or recurrent cholesteatoma.A retrospective analysis.Tertiary referral (...) center.Patients were included if 1) they had at least two postoperative DWI examinations after a canal wall up procedure with apparently complete cholesteatoma resection; 2) D-W MRI-1 was performed between 6 and 24 months after surgery and D-W MRI-2 performed at least 6 months after D-W MRI-1; 3) both DWI examinations were of good quality and covering the whole mastoid-middle ear region; 4) D-W MRI-1 was unequivocally negative for cholesteatoma; and 5) there was no clinical suspicion on otoscopy of recurrent

2016 Otology and Neurotology

145. Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery. (PubMed)

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery. Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing (...) ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.A literature search for all

2016 Journal of Laryngology & Otology

146. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. (PubMed)

Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies.Retrospective review and cost analysis.Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent (...) cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits.One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU

2016 Laryngoscope

147. Iatrogenic cholesteatoma arising from the vascular strip. (PubMed)

Iatrogenic cholesteatoma arising from the vascular strip. To highlight the phenomenon of cholesteatoma arising from the vascular strip following tympanoplasty and tympanomastoidectomy.Multi-institutional retrospective chart review.Consecutive adult and pediatric patients evaluated between 2000 and 2015 with acquired cholesteatoma arising from the skin of a prior vascular strip were identified. Patients with evidence of residual or recurrent cholesteatoma elsewhere in the middle ear, mastoid (...) , or ear canal were excluded.Seventeen cases (71% female, 53% right-sided) were identified, and the mean age at presentation was 39.2 years. Patients presented on average 12.9 years following prior otologic surgery, which was most commonly tympanoplasty without mastoidectomy (59%). However, younger patients presented with symptoms sooner following prior surgery (r = 0.61, r2 = 0.37, P = 0.0095). The most common presenting symptom was otorrhea (76%). All patients were found to have mastoid cholesteatoma

2016 Laryngoscope

148. Secondary Acquired Cholesteatoma: Presentation and Tympanoplasty Outcomes. (PubMed)

Secondary Acquired Cholesteatoma: Presentation and Tympanoplasty Outcomes. Comparing the clinical features and surgical outcomes of patients undergoing tympanoplasty for secondary acquired cholesteatoma (SAC) versus non-complicated tympanic membrane perforation (TMP).Retrospective patient review.Tertiary-care, academic center.All 41 patients with diagnosis of SAC confirmed at surgery between January 1, 2007 and June 30, 2014, and an age-matched cohort consisting of patients

2016 Otology and Neurotology

149. The Tightrope Facial Nerve-An Unsupported Mastoid Segment After Resection of Recidivistic Cholesteatoma. (PubMed)

The Tightrope Facial Nerve-An Unsupported Mastoid Segment After Resection of Recidivistic Cholesteatoma. Cholesteatomas are epidermal inclusion cysts containing stratified squamous epithelium that arise in the middle ear and mastoid cavities resulting in a persistent inflammatory state. Complications include chronic otorrhea, granulation tissue, and bony erosion. Cholesteatoma growth patterns predict frequent involvement of the Fallopian canal of the facial nerve. Extensive disease may extend (...) to the posterior and middle fossa dura, the otic capsule, the carotid artery, and the jugular bulb. Dehiscence of the Fallopian canal and direct involvement of the facial nerve epineurium by cholesteatoma are risk factors for intraoperative facial nerve injury during tympanomastoid surgery by exposing the facial nerve to mechanical trauma and inflammation during microdissection. We present two cases of recidivistic cholesteatoma with unusual medial involvement of the vertical segment of the facial nerve

2016 Otology and Neurotology

150. FleQ, a Transcriptional Activator, Is Required for Biofilm Formation In Vitro but Does Not Alter Virulence in a Cholesteatomas Model. (PubMed)

FleQ, a Transcriptional Activator, Is Required for Biofilm Formation In Vitro but Does Not Alter Virulence in a Cholesteatomas Model. Bacterial biofilm formation within cholesteatomas is responsible for increased persistence and tissue destruction and Pseudomonas aeruginosa deficient in biofilm formation (PAO1 ΔfleQ) are less virulent than the parent bacteria.Infected aural cholesteatomas have been demonstrated to be more destructive than uninfected cholesteatomas and infections are more (...) persistent. The chronicity and persistence of infections within cholesteatomas may be because of the presence of biofilm formation.Twenty-seven mutant strains of PAO1 were screened for surface adherence. These strains were also screened for static biofilm formation. The biofilms were quantified by staining with crystal violet. Aural cholesteatomas were then induced in Mongolian gerbils by ligation of the ear canal. At the time of ligation, the ear canals were inoculated with wild-type PAO1 and a biofilm

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2016 Otology and Neurotology

151. Cholesteatoma

Cholesteatoma Cholesteatoma Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Cholesteatoma Cholesteatoma Aka: Cholesteatoma From (...) Related Chapters II. Pathophysiology Benign squamous metaplasia of middle ear epithelium TM epithelium retracts into mastoid air cells Mass gradually expands and keratinizes Forms epithelial inclusion cyst Contains crystals and keratinous debris Results in destruction of middle ear ossicles III. Cause Congenital Cholesteatoma Acquired Cholesteatoma IV. Symptoms Ear fullness Chronic suppurative discharge from middle ear Via perforated V. Signs Middle ear deafness Pearly gray middle ear mass VI

2018 FP Notebook

152. Sensorineural Hearing Loss in Cholesteatoma. (PubMed)

Sensorineural Hearing Loss in Cholesteatoma. To determine whether middle ear cholesteatoma is associated with, sensorineural hearing loss, and whether patient age, cholesteatoma growth pattern, or, air bone gap size contribute to inner ear impairment.Cross-sectional comparative.A tertiary hospital.The subjects were 115 patients with middle ear cholesteatoma in one ear, and normal video-otoscopy in the contralateral ear (CLE).Otoendoscopy, pure-tone audiometry.Bone conduction (BC) threshold (...) differences between the normal CLE and the cholesteatoma ear. Comparisons of these differences between different cholesteatoma growth patterns. Correlation between the air bone gap size in the ear with cholesteatoma and the difference in bone conduction thresholds between both ears.The cholesteatoma ear was associated with greater BC thresholds than the CLE. With regard to different cholesteatoma growth patterns, the differences between associated BC thresholds were also significant in all groups at all

2016 Otology and Neurotology

153. Sanna Classification and Prognosis of Cholesteatoma of the Petrous Part of the Temporal Bone: A Retrospective Series of 81 Patients. (PubMed)

Sanna Classification and Prognosis of Cholesteatoma of the Petrous Part of the Temporal Bone: A Retrospective Series of 81 Patients. To determine how classification of petrous bone cholesteatomas (PBCs) using the 5-point Sanna classification can predict major structural involvement, facial nerve outcomes, hearing outcomes, postoperative complications, and disease recurrence.Retrospective case series.Tertiary referral center in Bergamo, Italy.Eighty-one sequential patients with radiologic

2016 Otology and Neurotology

154. Depression and cholesteatoma: Preliminary findings from a nationwide population-based retrospective cohort study. (PubMed)

Depression and cholesteatoma: Preliminary findings from a nationwide population-based retrospective cohort study. To estimate the risk of developing depressive disorder (DD) following diagnosis with cholesteatoma.In the study, we analyzed data from the Longitudinal Health Insurance Database of Taiwan. A total of 599 patients newly diagnosed with cholesteatoma between 1997 and 2007 were included with a comparison cohort of 2995 matched non-cholesteatoma enrollees. Each patient was followed for 3 (...) years to identify the subsequent development of DD. Cox proportional hazard regression analysis was performed to compute adjusted 3-year hazard ratios.The incidence of DD per thousand person-years was approximately twice as high among patients with cholesteatoma (11.32) as among those without cholesteatoma (5.85). After adjusting for potential confounders, patients with cholesteatoma were 1.99 times (95% CI=1.18-3.34, P=0.010) more likely to suffer from DD within 3 years compared to those without

2016 Journal of Affective Disorders

155. Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients. (PubMed)

Analysis of histopathological aspects and bone destruction characteristics in acquired middle ear cholesteatoma of pediatric and adult patients. The aim of this study was to investigate the proliferative and apoptotic activity of middle ear cholesteatoma in pediatric and adult patients, in addition to comparing its histopathological aspects and the severity of advanced bone destruction.Medical records of 223 patients treated for chronic otitis media with cholesteatoma at the Otolaryngology (...) Department of Dokuz Eylul University between January 1992 and December 2013 were retrospectively evaluated. Sixty-one patients subjected to tympanomastoidectomy due to middle ear cholesteatoma, with sufficient specimens for histopathological examination, were included in the study. Sections of archived tissues in paraffin blocks were subjected to new histopathological examinations. The proliferative and apoptotic activities of cholesteatoma were determined by immunohistochemical staining for epithelial

2016 International Journal of Pediatric Otorhinolaryngology

156. Classification of Cholesteatoma According to Growth Patterns. (PubMed)

Classification of Cholesteatoma According to Growth Patterns. Several classifications of cholesteatoma exist, but there are controversies about their clinical application.To classify cholesteatomas and describe the prevalence of the subtypes.A cross-sectional comparative study of 414 ears in 356 consecutive patients with middle ear cholesteatoma and no history of ear surgery treated at a tertiary hospital was conducted from March 8, 2000, to March 30, 2015. Data analysis was conducted from (...) patients (61.8%). A total of 272 (65.7%) ears were from adults. Of the 414 ears that underwent otoendoscopy, posterior epitympanic (142 [34.3%]) and posterior mesotympanic (140 [33.8%]) were the most frequent types of cholesteatoma observed, followed by undetermined (67 [16.2%]) and 2 routes (57 [13.8%]). Anterior epitympanic type was the least frequent (8 [1.9%]). Posterior epitympanic cholesteatoma was more prevalent in adults (111 [40.8%]), whereas posterior mesotympanic cholesteatoma was more

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2016 JAMA otolaryngology-- head & neck surgery

157. Management of pediatric cholesteatoma based on presentations, complications, and outcomes. (PubMed)

Management of pediatric cholesteatoma based on presentations, complications, and outcomes. To highlight important aspects and paradigms in the management of paediatric cholesteatoma in a developing world setting.A retrospective audit was conducted of paediatric cholesteatomas that underwent tympanomastoid surgery between 2008 and 2012 at the Red Cross War Memorial Children's Hospital in Cape Town. The following was audited: initial presentation; cholesteatoma complications; types of surgery (...) , intraoperative findings and outcomes of surgery in terms of hearing, otorrhoea and recidivism; and the reliability of follow-up and how this might influence the type of surgery.Fifty-seven children aged 2-13 years with 61 cholesteatomas (4 bilateral) were reviewed. Fifty-five mastoidectomies were done; 11% presented with complicated cholesteatoma. Referrals from primary care were significantly delayed (>6 months) in 76%. Canal wall down surgery was done in 71%. Forty-five percent had improved hearing (within

2016 International Journal of Pediatric Otorhinolaryngology

158. Fusion of Computed Tomography and PROPELLER Diffusion-Weighted Magnetic Resonance Imaging for the Detection and Localization of Middle Ear Cholesteatoma. (PubMed)

Fusion of Computed Tomography and PROPELLER Diffusion-Weighted Magnetic Resonance Imaging for the Detection and Localization of Middle Ear Cholesteatoma. A method to optimize imaging of cholesteatoma by combining the strengths of available modalities will improve diagnostic accuracy and help to target treatment.To assess whether fusing Periodically Rotated Overlapping Parallel Lines With Enhanced Reconstruction (PROPELLER) diffusion-weighted magnetic resonance imaging (DW-MRI (...) ) with corresponding temporal bone computed tomography (CT) images could increase cholesteatoma diagnostic and localization accuracy across 6 distinct anatomical regions of the temporal bone.Case series and preliminary technology evaluation of adults with preoperative temporal bone CT and PROPELLER DW-MRI scans who underwent surgery for clinically suggested cholesteatoma at a tertiary academic hospital. When cholesteatoma was encountered surgically, the precise location was recorded in a diagram of the middle ear

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2016 JAMA otolaryngology-- head & neck surgery

159. Reexamination of Etiology and Surgical Outcome in Patient With Advanced External Auditory Canal Cholesteatoma. (PubMed)

Reexamination of Etiology and Surgical Outcome in Patient With Advanced External Auditory Canal Cholesteatoma. To describe the etiology of advanced cases of external auditory canal (EAC) cholesteatoma (EACC), and to report the surgical management and outcomes based on canalplasty depending on the extent of adjacent structures involvement around the EAC.Retrospective case review.University hospital.Participants comprised 28 patients (12 males, 16 females) ranging in age from 9 to 86 years old (...) to the jugular bulb, multi-layered repair including bone paste, post-auricular pedicled musculo-periosteal flap, auto cartilage, and temporalis muscle fascia were required. Five patients required revision surgery (17%), including one case of recurrent (reconstructed) cholesteatoma and three cases of perforation of the tympanic membrane.In the majority of our series, underlying diseases followed with microangiopathy and angiogenesis could be possible candidates in the etiology of EACC. Enlarged bony

2016 Otology and Neurotology

160. Clinical characteristics of pediatric external auditory canal cholesteatoma. (PubMed)

Clinical characteristics of pediatric external auditory canal cholesteatoma. External auditory canal cholesteatoma (EACC) is caused by an invasion of squamous tissue into a localized area of periosteitis in the bony canal wall. The clinical characteristics of pediatric EACC are still unknown because of its rare occurrence. To date, only a single paper has reported that pediatric EACC has a less aggressive growth pattern compared to adult EACC. Further studies are required to understand

2016 International Journal of Pediatric Otorhinolaryngology

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