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The value of otoendoscopy in the management of middle ear cholesteatoma The surgical management of cholesteatoma is a controversial issue, particularly regarding intact-canal-wall mastoidectomy (ICWM) versus canal-wall-down mastoidectomy (CWDM). The current experiment compared the quality of visualization in different middle ear structures using ICWM with otoendoscopy with findings of CWDM by microscopy.The patients diagnosed with cholesteatoma underwent tympanomastoidectomy (...) , and then the patients selected for CWDM were included in the study (25 patients: 11 females and 14 males). After removing the cholesteatoma from the involved areas, otoendoscopic examination was done with a 4 mm, 0° endoscope by a neurootologist. All five middle ear structures (lateral epitympanum, sinus tympani, posterior crus of the stapes, round window niche, and Eustachian tube orifice) suspected of occult cholesteatoma were evaluated in terms of having or lacking the pathology. Then, CWDM was performed and all
Is Cholesteatoma a Risk Factor for Graft Success Rate in Chronic Otitis Media Surgery? In developing countries, chronic otitis media (COM) and cholesteatoma are relatively prevalent. Within the field of otology, COM surgery remains one of the most common surgical treatments. Most recent studies evaluating the potential prognostic factors in COM surgery have addressed graft success rate and types of middle ear and mastoid pathology. There has been much controversy about this issue until (...) the present time. This study evaluated the effect of cholesteatoma on the GSR in COM surgery.The present retrospective, case-controlled study investigated 422 ears undergoing COM surgery. The minimum and maximum postoperative follow-up periods were 6 and 48 months, respectively. The study group consisted of patients with cholesteatomatous COM, while the control group included patients with non-cholesteatomatous COM, who had undergone ear surgery. Postoperative graft success rate and audiological test
Transcanal CO2 laser-enabled ablation and resection (CLEAR) for intratympanic membrane congenital cholesteatoma. Cholesteatoma in the tympanic membrane is frequently regarded as congenital but there has been no case series review or comparison study with typical pediatric congenital cholesteatoma (CC).All pediatric CC cases from 2009 to 2014 were collected, and a total of 10 cases of intratymapnic membrane CC (ICC) out of 429 CC cases were reviewed. They were compared with 14 cases
A study of mastoid pneumatisation and the presence of cholesteatoma in 393 patients. This study aimed to evaluate the relationship between cholesteatoma formation and the degree of mastoid pneumatisation, and to assess the relationship between the location of cholesteatoma and the degree of mastoid pneumatisation.Data on all patients undergoing mastoid exploration for cholesteatoma between 1993 and 2011 were collected prospectively. Basic demographics, the degree of mastoid pneumatisation (...) and cholesteatoma site were recorded.A total of 393 patients (222 males and 171 females) underwent surgery for cholesteatoma. Patients' mean age was 37 years (range, 6-79 years). Pneumatisation of the mastoid was sclerotic in 23 per cent (n = 90), diploic in 16.7 per cent (n = 66) and cellular in 60.3 per cent of cases (n = 237) (p < 0.001). Atticoantral disease was present in 88.9 per cent of sclerotic, 95.4 per cent of diploic and 91.1 per cent of cellular mastoids. Middle-ear cholesteatoma was present
Comparing diffusion weighted MRI in the detection of post-operative middle ear cholesteatoma in children and adults. There is a limited evidence base for the use of diffusion weighted MRI (DWMRI) in the assessment of post-operative cholesteatoma in children. This is important to address as this technique is particularly relevant in a paediatric setting.We searched a prospectively collected database of patients undergoing DWMRI for the assessment of residual and recurrent cholesteatoma. Imaging
Congenital Cholesteatoma Localized to the Mastoid Cavity and Presenting as a Mastoid Abscess Introduction. Congenital cholesteatoma is a pearly white mass that rarely originates from the mastoid process. Case Report. A 21-year-old male patient presented to our department with severe right mastoid pain and postauricular fluctuant swelling for 23 days. There was no preceding history of ear complaints and examination showed a normal right ear drum. Emergency exploration of the mastoid process (...) was done on the same day and revealed localized cholesteatoma limited only to the mastoid cavity. Conclusion. Despite a rarity, the mastoid process should be always put in mind as a site of origin for congenital cholesteatoma.
NOD-Like Receptor Signaling in Cholesteatoma Background. Cholesteatoma is a destructive process of the middle ear resulting in erosion of the surrounding bony structures with consequent hearing loss, vestibular dysfunction, facial paralysis, or intracranial complications. The etiopathogenesis of cholesteatoma is controversial but is associated with recurrent ear infections. The role of intracellular innate immune receptors, the NOD-like receptors, and their associated signaling networks (...) was investigated in cholesteatoma, since mutations in NOD-like receptor-related genes have been implicated in other chronic inflammatory disorders. Results. The expression of NOD2 mRNA and protein was significantly induced in cholesteatoma compared to the external auditory canal skin, mainly located in the epithelial layer of cholesteatoma. Microarray analysis showed significant upregulation for NOD2, not for NOD1, TLR2, or TLR4 in cholesteatoma. Moreover, regulation of genes in an interaction network
Non-classical presentation of congenital cholesteatoma as cerebrospinal fluid rhinorrhea - Case report and systematic review of the literature. Congenital cholesteatoma (CC) becomes clinically apparent as a cholesteatoma usually during childhood. Nontraumatic otogenic cerebrospinal fluid (CSF) rhinorrhea with an intact tympanic membrane is a very rare symptom.The review of recent literature and case report of the 60-year old patient - a trumpeter presented with nontraumatic otogenic CSF (...) rhinorrhea, intact tympanic membrane on microotoscopy, and besides colorless fluid in right nasal cavity, normal finding on nasal endoscopy examination.CSF rhinorrhea was caused by CC in the petrous bone apex. Early diagnosis was facilitated by computed tomography scanning. Complete cholesteatoma removal was accomplished using a middle fossa craniotomy and an open non-radical antromastoidectomy.The diagnosis of otogenic cerebrospinal fluid (CSF) rhinorrhea is challenging and it can easily be misdiagnosed
Magnetic resonance imaging at one year for detection of postoperative residual cholesteatoma in children: Is it too early? To compare the residual cholesteatoma detection accuracy of diffusion-weighted (DW) and T1 delayed sequences for magnetic resonance at one year postoperative with second-look surgery in pediatric patients who have undergone primary middle ear surgery for cholesteatoma.This was a prospective monocentric consecutive study conducted in a tertiary academic referral center (...) included. Sensitivity, specificity, positive predictive value, and negative predictive value for the first observer were of 40%, 86%, 67%, and 67%, respectively, and those for the second observer were 30%, 86%, 60%, and 63%, respectively. The only two cholesteatoma with a size superior to 3mm were diagnosed before surgery, but the majority of small cholesteatoma were not detected.MRI is a key examen to diagnosed the residual cholesteatoma but is limited by the size of the lesion under 3mm. Delaying
Atypical presentation of congenital cholesteatoma in an adult case with good hearing result Congenital cholesteatoma is thought to be caused by inadequate folding of the epidermoid formation inside the middle ear cleft. During development of the middle ear mucosa, stratified squamous epithelium accumulates in the embryonic life. Its typical appearance is a "pearl" beneath the anterosuperior quadrant of the tympanic membrane.We report 28 years-old case with congenital cholesteatoma (...) in the posterosuperior quadrant of middle ear cavity. The main complaint was the hearing loss which had developed slowly over several years.The case was surgically treated. Postoperative hearing result was satisfactory.Congenital cholesteatoma may occur in atypical locations and ages. Many authors prefer canal wall down tympanomastoidectomy. But it can also be treated successfully by intact canal wall tympanomastoidectomy with good hearing results.
Computed Tomography Staging of Middle Ear Cholesteatoma To establish computed tomography (CT) staging of middle ear cholesteatoma and assess its impact on the selection of the surgical procedure.Prospective study was conducted on 61 consecutive patients (mean age 26.8 years) with middle ear cholesteatoma. CT scan of the temporal bone and surgery were performed in all patients. CT staging classified cholesteatoma according to its location in the tympanic cavity (T); extension into the mastoid (M (...) ); and associated complications (C). Cholesteatoma was staged as stage I (T1, T2), stage II (T3, M1, M2, C1), and stage III (C2).The overall sensitivity of CT staging of cholesteatoma compared to surgery was 88% with excellent agreement and correlation between CT findings and intra-operative findings (K=0.863, r=0.86, P=0.001). There was excellent agreement and correlation of CT staging with surgical findings for T location (K=0.811, r=0.89, P=0.001), good for M extension (K=0.734, r=0.88, P=0.001
Increased Acquired Cholesteatoma Risk in Patients with Osteoporosis: A Retrospective Cohort Study Clinically, we found the increased incidence of acquired colesteatoma in the patients with osteoporosis. In this study, we used a retrospective cohort to examine this association and to investigate the possible mechanism.We conducted a population-based retrospective cohort study by using the National Health Insurance Research Database (NHIRD). We identified an osteoporosis cohort comprising 37 124 (...) patients newly diagnosed with osteoporosis aged 20 years or older. Patients in the comparison cohort had no history of osteoporosis and were frequency matched with the patients in the osteoporosis cohort according to sex, age, and index year.The acquired cholesteatoma incidence rates for the osteoporosis and comparison cohorts were 1.12 and 0.83 per 1000 person-years, respectively. After we adjusted for confounding factors, the osteoporosis cohort exhibited a 1.32-fold increased acquired cholesteatoma
Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding
A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Although the migration of its squamous outer surface of the tympanic membrane has been well characterized, there is a paucity of data available concerning the migratory behavior of its medial mucosal surface. Existing theories of primary acquired cholesteatoma pathogenesis do not adequately explain the observed characteristics of the disease. We propose a new hypothesis, based upon a conjecture that mucosal membrane (...) interactions are the driving force in cholesteatoma.A retrospective chart review and a prospective observational cohort study in rats.After developing the new theory, it was tested through both clinical and experimental observations. To evaluate whether impairment of middle ear mucociliary migration would influence cholesteatoma formation, a retrospective chart review evaluating cholesteatoma occurrence in a sizable population of patients with either primary ciliary dyskinesia (PCD) or cystic fibrosis (CF
Hearing Impairment in Children and Adults With Acquired Middle Ear Cholesteatoma: Audiometric Comparison of 385 Ears. Evaluate hearing impairment in acquired middle ear cholesteatoma and investigate audiometric differences between children and adults.Cross-sectional comparative study.Tertiary hospital.Three hundred twenty-three consecutive patients diagnosed as having acquired middle ear cholesteatoma in at least one ear (385 ears) between August 2000 and March 2013 and no surgical history (...) had profound hearing loss, without a significant difference between children and adults. The AC and BC thresholds were significantly greater in adults at all the frequencies (p ≤ 0.05), but the ABGs were not significantly different between the age groups.Acquired middle ear cholesteatoma is associated with significant hearing impairment, although profound hearing loss is rare. Adults have greater AC and BC thresholds than those in children but similar ABGs to children.
Mastoid obliteration surgery for cholesteatoma in 183 adult ears - a 5-year prospective cohort study. 25891851 2016 10 18 2016 12 30 1749-4486 40 6 2015 Dec Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Clin Otolaryngol Mastoid obliteration surgery for cholesteatoma in 183 adult ears--a 5-year prospective cohort study: Our Experience. 721-6 10.1111/coa.12444 Trinidade A A Department of ENT (...) , Ipswich General Hospital, Ipswich, UK. Skingsley A A Imperial College, London, UK. Yung M W MW Department of ENT, Ipswich General Hospital, Ipswich, UK. eng Letter England Clin Otolaryngol 101247023 1749-4478 IM Adolescent Adult Aged Cholesteatoma, Middle Ear surgery Female Follow-Up Studies Humans Male Mastoid surgery Middle Aged Prospective Studies Time Factors Treatment Outcome Tympanoplasty methods Young Adult 2015 04 05 2015 4 21 6 0 2015 4 22 6 0 2016 10 19 6 0 ppublish 25891851 10.1111/coa
Labyrinthine function after semicircular canal surgery on seventeen patients with cholesteatoma. 25929199 2016 10 25 2016 12 30 1749-4486 41 1 2016 Feb Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Clin Otolaryngol Labyrinthine function after semicircular canal surgery on seventeen patients with cholesteatoma. 76-9 10.1111/coa.12453 Hirvonen T P TP Department of Otolaryngology, University (...) of Helsinki and Helsinki University Hospital, Helsinki, Finland. Aalto H H Department of Otolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Jutila T T Department of Otolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. eng Letter England Clin Otolaryngol 101247023 1749-4478 IM Adolescent Adult Aged Cholesteatoma surgery Ear, Inner physiology Female Humans Male Middle Aged Semicircular Canals physiology surgery Young Adult 2015
Osseous Eustachian Tube and Peritubal Cells in Patients with Unilateral Cholesteatoma Comparison Between Healthy and Diseased Sides Using High-Resolution Cone-Beam Computed Tomography. We investigated the factors that may possibly cause primary acquired cholesteatoma.University-affiliated hospital.In 20 adult patients with unilateral cholesteatoma, the sizes of the osseous eustachian tubes (ETs) and the extent of peritubal and mastoid cell development in healthy and diseased ears were examined (...) using high-resolution cone-beam computed tomography. The height and width of the ET were measured at the tympanic orifice, the isthmus, and the midpoint, as was the length of its axis. We also assessed the extent of development of peritubal and mastoid cells.There were no significant differences in the size of the osseous ET between the healthy and cholesteatoma sides, but significant correlations were found in height and width between the sides at the tympanic orifice and at the isthmus. In 80
Endoscopic exclusive transcanal approach to the tympanic cavity cholesteatoma in pediatric patients: Our experience. The aim of the present study is to describe our experience in the management of tympanic cavity cholesteatoma in pediatric patients, treated with endoscopic exclusive transcanal approach.A chart review of clinical data and videos from the operations of 54 pediatric patients, undergoing surgery between January 2007 and December 2013, was made. Patients presenting (...) with cholesteatoma involving the tympanic cavity (mesotympanum, epitympanum, protympanum and/or hypotympanum), with no mastoid involvement, were included in the first group and underwent an exclusive transcanalar endoscopic approach (TEA). In case of mastoid extension of the pathology, patients were included in the control group and underwent a canal wall up microscopic technique (CWU).In this study, 34 males and 20 females, including 5 bilateral cases, giving a total of 59 ears, were reviewed. Median age
The impact of ventilation tubes in otitis media on the risk of cholesteatoma on a national level. To estimate the impact of treatment with middle ear ventilation tube insertion (VTI) in children with otitis media (OM) on the risk of cholesteatoma on a national level.Data were obtained from the Danish National Patient Register, the National Health Service Register and Statistics Denmark. Cumulative incidence proportions were estimated by the Kaplan-Meier method and hazard ratios with Cox (...) regression analysis. The first surgically treated middle ear cholesteatoma in a child (STMEC1) was considered an event.A total of 217,206 children, born after December 31, 1996, who had VTI from January 1, 1997 to August 31, 2011 were identified. Of these, 374 subsequently had a STMEC1. A corresponding 36,981 children without any VTI were identified for comparison using a random 5% sample of the Danish population. Of these, 5 had a STMEC1. The cumulative incidence proportion with STMEC1 at 12 years