A multivariate analysis of the factors predicting hearing outcome after surgery for cholesteatoma in children

2006 ◽  
Vol 120 (11) ◽  
pp. 908-913 ◽  
Author(s):  
N K Chadha ◽  
A Jardine ◽  
D Owens ◽  
S Gillett ◽  
P J Robinson ◽  
...  
Keyword(s):  
Canal Wall ◽  
Hearing Outcome ◽  
Cohort Differences ◽  
Canal Wall Down ◽  
Hearing Outcomes ◽  
Mastoid Surgery ◽  
Disease Free ◽  
Canal Wall Up ◽  
Air Conduction

Objective: To explore factors influencing hearing outcomes in children treated by canal wall up (CWU) and canal wall down (CWD) mastoid surgery.Methods: Retrospective cohort study including three units in Bristol and Bath, UK. Ninety consecutive children underwent cholesteatoma mastoid surgery, with the first procedure between 1998 and 2001; minimum follow up was three disease-free years.Results: The CWU and CWD cohorts significantly differed in pre-operative stage and hearing. After disease eradication, air conduction (AC) thresholds changed by +4.0 dB (95 per cent confidence intervals (95%CI) −2.0, 10.1) in the CWD group and −5.3 dB (95%CI −9.3, 1.3) in the CWU group (p=0.029). Using multiple linear regression to account for cohort differences, AC thresholds were increased by: pre-operative AC threshold (p<0.0001), initial ossicular stage (p=0.013), and CWD-surgery (p=0.005).Conclusion: Disease-free hearing was better with CWU-surgery, less initial ossicular damage, and better pre-operative hearing. Worse initial disease increased the likelihood of CWD surgery. Wider use of ossiculoplasty in the CWU cohort (51 per cent vs 5 per cent) may partially explain the superior results.

scholarly journals Correlation between functional outcome and the SAMEO-ATO framework

2021 ◽  
Author(s):  
Vito Pontillo ◽  
Marialessia Damiani ◽  
Giusi Graziano ◽  
Nicola Quaranta
Keyword(s):  
Functional Outcome ◽  
Middle Ear ◽  
Petrous Bone ◽  
Canal Wall ◽  
Hearing Results ◽  
Tertiary Referral Center ◽  
Ossicular Reconstruction ◽  
Canal Wall Down ◽  
Mastoid Surgery ◽  
Canal Wall Up

Abstract Purpose To evaluate the recently proposed SAMEO-ATO framework for middle ear and mastoid surgery, by correlating it with the functional outcome in a large cohort of patients operated for middle ear and mastoid cholesteatoma in a tertiary referral center. Methods We retrospectively included all surgeries for middle ear and mastoid cholesteatoma undergone in our Department between January 2009 and December 2014, by excluding revision surgeries, congenital and petrous bone cholesteatoma. All surgeries were classified according to the SAMEO-ATO framework. The post-operative air bone gap (ABG) was calculated and chosen as benchmark parameter for the correlation analysis. Results 282 consecutive surgeries for middle ear and mastoid cholesteatoma were released in the study period on a total of 273 patients, with a mean age of 41.2 years. All patients were followed for an average period of 55.3 months. 54% of patients underwent M2c mastoidectomy (Canal Wall Down, CWD), while the remaining underwent Canal Wall Up (CWU) procedures, being M1b2a mastoidectomy the most common one (33%). Mean pre-operative and post-operative ABGs were 29.2 and 23.5 dB, with a significant improvement (p < 0.0001). ‘Mastoidectomy’ and ‘Ossicular reconstruction’ parameters of SAMEO-ATO showed significant association with postoperative ABG, with smaller residual gaps for the classes Mx and On, and worse hearing results for M3a and Ox. Conclusion Our results show the utility of SAMEO-ATO framework, and in particular of ‘M’ (Mastoidectomy) and ‘O’ (Ossicular reconstruction) parameters, in predicting the hearing outcome.

Hearing Outcomes Following Type 3 Tympanoplasty With Stapes Columella Grafting in Canal Wall Down Mastoidectomy

2019 ◽  
Vol 128 (8) ◽  
pp. 736-741
Author(s):  
C. Burton Wood ◽  
Brendan P. O’Connell ◽  
Anne C. Lowery ◽  
Marc L. Bennett ◽  
George B. Wanna
Keyword(s):  
Care Center ◽  
Cohort Analysis ◽  
Tertiary Care ◽  
Canal Wall ◽  
Short Term ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Hearing Outcomes ◽  
Type 3

Objectives: To analyze hearing outcomes following Type 3 tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and determine disease recurrence rates in patients undergoing this procedure. Methods: This retrospective cohort analysis examines patients undergoing Type 3 tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if they were found to have undergone the aforementioned procedure. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 6 months and 1 year postoperatively. Results: Nineteen patients met criteria for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 37% of cases, highlighting disease severity. Eighteen (95%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 26 ± 11 dB HL; 26% achieved an ABG <20 dB, and 58% achieved an ABG <30 dB. Fifteen had follow-up at least 1 year postoperatively (mean = 33 ± 16 months). At longer-term follow-up, mean ABG was 25 ± 10 dB HL; 33% achieved an ABG <20 dB, while 66% achieved an ABG <30 dB. Hearing remained stable over time ( P = .52). At date of last clinical follow-up, only 1 (5%) patient had undergone revision for recurrent disease. Conclusion: In some patients undergoing canal wall down mastoidectomy for advanced or recurrent cholesteatoma, Type 3 tympanoplasty with stapes columella grafting yields marginal hearing benefit. This type of reconstruction is a viable option in this challenging patient cohort, particularly as it is associated with low rates of revision surgery.

Cholesteatoma in the Pediatric Age Group

1988 ◽  
Vol 97 (1) ◽  
pp. 23-29 ◽  
Author(s):  
David R. Edelstein ◽  
Simon C. Parisier ◽  
Patricia Chute ◽  
Gurpreet S. Ahuja ◽  
Shula Wenig ◽  
...  
Keyword(s):  
Residual Disease ◽  
Senior Author ◽  
Canal Wall ◽  
Pediatric Age Group ◽  
Patient Questionnaires ◽  
Tube Function ◽  
Canal Wall Down ◽  
Extent Of Disease ◽  
Canal Wall Up

The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31 %, and a canal wall down procedure in 52.3 %. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8 % of patients, and recurrent disease in only 3 %.

scholarly journals Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

2021 ◽  
Vol 7 (3) ◽  
pp. 481
Author(s):  
Udayachandrika Gangadaran ◽  
Muthuchitra S. ◽  
Mary Nirmala S. ◽  
Ramya Devi K.
Keyword(s):  
Canal Wall ◽  
Hearing Gain ◽  
Medical College ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
The Cost ◽  
Postoperative Improvement ◽  
Canal Wall Up ◽  
Air Conduction ◽  
Ethical Clearance

<p><strong>Background: </strong>The aim of the study is to compare the efficacy of autologous incus versus allogenic titanium prosthesis in terms of anatomical results, hearing gain after surgery, operative course and complications.</p><p><strong>Methods:</strong> This is a prospective interventional study of 20 patients out of which 10 underwent autologus incus and 10 underwent titanium prosthesis ossiculoplasties performed between April 2018 To April 2019 in Government Kilpauk medical college and hospital, Chennai after ethical clearance. The postoperative improvement of mean air-bone gap and air conduction over same frequencies between the two groups were studied. A improvement in pure tone average more than 10 dB was considered successful.</p><p><strong>Results:</strong> In current study, 10 patients underwent ossiculoplasties using titanium ossicular replacement prosthesis and 10 patients underwent ossiculoplasties using autologous incus. 5 of the patients in each group underwent canal wall up and 5 underwent canal wall down procedure. The average ABG closure was 9.30 dB in incus group and 15.22 dB in titanium group.</p><p><strong>Conclusions: </strong>Titanium ossicular prosthesis ossiculoplasties provide a significant hearing gain and are advantageous because of the easy insertion with pre-sculpted structure yet the cost is a concern. Better results were noted in canal wall up procedures more than canal wall down procedures.</p>

scholarly journals A comparative study of hearing outcomes in canal wall up versus canal wall down mastoidectomy in our experience

2019 ◽  
Vol 5 (2) ◽  
pp. 472
Author(s):  
Poornima S. Bhat ◽  
G. Gandhi ◽  
K. Pradheep
Keyword(s):  
Hearing Loss ◽  
Conductive Hearing Loss ◽  
Pure Tone Audiometry ◽  
Canal Wall ◽  
Hearing Gain ◽  
Hearing Outcome ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
Conductive Hearing ◽  
Canal Wall Up

<p class="abstract"><strong>Background:</strong> COM causes considerable morbidity with ear discharge, conductive hearing loss and complications. Ossicular reconstruction is a surgical procedure which intends to improve the quality of hearing and life in such patients. Comparison of the outcomes will help to determine the merits or demerits of a particular procedure.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of ENT, VIMS, Bellary during the period from December 2010 to May 2012. All the patients with CSOM with ossicular erosion suggested by conductive hearing loss more than 40dB were included in the study. A detailed history taking, thorough clinical examination was done for these patients. Before and after the procedure pure tone audiometry was done to assess the hearing outcome. Post operatively PTA was done in 6<sup>th</sup> week, 3<sup>rd</sup> month, 6<sup>th</sup> month follow up. Hearing improvement was analysed according to the type of procedure. The data collected was tabulated and subjected to statistical analysis.  </p><p class="abstract"><strong>Results:</strong> This study compared the outcomes of hearing gain in canal wall up versus canal wall down mastoidectomy surgeries. Hearing gain was better in canal wall up mastoidectomy (18.36 dB) than canal wall down mastoidectomy surgeries.</p><p class="abstract"><strong>Conclusions:</strong> Hearing outcome was better in intact canal wall mastoidectomy than canal wall down mastoidectomy in our study.</p><p class="abstract"> </p>

Surgical Treatment of Labyrinthine Fistula Caused by Cholesteatoma

2000 ◽  
Vol 122 (5) ◽  
pp. 739-742 ◽  
Author(s):  
Antonio Soda-Merhy ◽  
Miguel Angel Betancourt-Suárez
Keyword(s):  
Chronic Otitis Media ◽  
Safe Procedure ◽  
Canal Wall ◽  
Cochlear Function ◽  
Horizontal Semicircular Canal ◽  
Labyrinthine Fistula ◽  
The Matrix ◽  
Preoperative Ct ◽  
Canal Wall Down

In a 144-month period, 27 cases of labyrinthine fistula (LF) were seen, and 360 mastoid operations were performed; the LF prevalence was 7.5%. Primary symptoms were hypoacusis, otorrhea, vertigo, tinnitus, and otalgia. All patients underwent preoperative CT scans and preoperative audiometry. LF diagnosis was made before surgery for 93% of patients on the basis of symptoms, signs, and imaging studies. With respect to surgical technique, the canal-wall-down procedure was performed in 92%, and the canal-wall-up procedure was performed in 8%. In 88% of patients the fistula was located in the horizontal semicircular canal. In 96% of patients the cholesteatoma matrix was removed, and the fistula was sealed; in 4% of patients the matrix was left. With a follow-up of 13 years, vertigo disappeared in 96% of patients, and hearing remained unchanged in 70% of patients. Further complications of chronic otitis media existed in approximately half of the patients with LF. Open surgery with removal of the cholesteatoma matrix and sealing of the fistula with temporalis fascia in a canal-wall-down manner is a safe procedure that can make vertigo disappear and helps to preserve cochlear function.

Autologous total ossicular replacement prosthesis

2014 ◽  
Vol 128 (12) ◽  
pp. 1050-1055 ◽  
Author(s):  
M Malhotra ◽  
S Varshney ◽  
R Malhotra
Keyword(s):  
Pure Tone ◽  
Chronic Otitis Media ◽  
Canal Wall ◽  
Hearing Improvement ◽  
Hearing Results ◽  
Replacement Technique ◽  
Ossicular Replacement ◽  
Canal Wall Down ◽  
Replacement Prosthesis ◽  
Air Conduction

AbstractObjective:To develop an autologous total ossicular replacement prosthesis with sustainable hearing results.Methods:The ears of 40 patients, who had chronic otitis media with absent suprastructure of the stapes and long process of the incus, were repaired using the autologous total ossicular replacement technique. Post-operative results were evaluated after 6 and 12 months on the basis of average pure tone air conduction and average air–bone gap measured at 0.5, 1, 2 and 3 kHz.Results:Successful rehabilitation of pure tone average to 30 dB or less was achieved in 75 per cent of patients, and air–bone gap to 20 dB or less was attained in 82.5 per cent of patients. Overall mean improvement in air–bone gap was 23.9 ± 8.5 dB (p < 0.001). Mean improvements in air–bone gap were significantly greater (p < 0.05) in the tympanoplasty only group (27.3 ± 6.6 dB) and the intact canal wall tympanoplasty group (25.9 ± 6.3 dB) than in the canal wall down tympanoplasty group (16.3 ± 8.9 dB).Conclusion:This paper describes an autologous total ossicular replacement prosthesis that is biocompatible, stable, magnetic resonance imaging compatible and, above all, results in sustainable hearing improvement.

scholarly journals Innovative Method of Using Endoscope in Postoperative Canal Wall Down Mastoid Cavity

2018 ◽  
Vol 56 (211) ◽  
pp. 650-653 ◽  
Author(s):  
Meera Bista ◽  
Nayan Bahadur Mahato ◽  
Deepak Regmi
Keyword(s):  
Study Data ◽  
Mastoid Cavity ◽  
P Value ◽  
Fisher Exact Test ◽  
Wide Field ◽  
Canal Wall ◽  
Cross Sectional ◽  
Significant Difference ◽  
Canal Wall Down ◽  
Mastoid Surgery

Introduction: Poor access to the difficult areas in the middle ear and mastoid cavity is considered as the major reason for failure in mastoid surgery. Wide field visibility, visualization of nooks and corners by an endoscope could contribute to better clinical control of the disease in these patients that cannot be accessed by the operating microscope.  Methods: This was a descriptive cross-sectional study, done in Kathmandu Medical College from January to June 2017. Thirty two patients were included in the study. Data collection was done by convenient sampling. Statistical analysis was done by Chi square test and Fisher Exact test, P value of <0.005 was considered statistically significant. Results: The study revealed that exposure benefit with an endoscope in canal wall down mastoid surgery was significantly better than with a microscope (P value of 0.034). The level of complete clearance and level of difficulty in cleaning with the help of a microscope compared to endoscope did not show a significant difference with P value of 0.288 and 0.652 obtained by Fisher extract test respectively. After microscopic removal of materials from the mastoid cavity, 22 (68.8%) which is more than half of cases had remaining materials in the cavity which was removed by endoscope completely. Conclusions: Outcome will make the ENT surgeons aware of use of endoscopy in post mastoid follow up cases to give better results and make the surgeon much more successful in his/her endeavor to eradicate the disease.

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