The classification of tympanomastoid surgery for cholesteatoma by the new SAMEO-ATO system in clinical practice

2021 ◽  
Vol 70 (1) ◽  
pp. 15-21
Author(s):  
Michal Homoláč ◽  
Tomáš Valenta ◽  
Lukáš Školoudík ◽  
Jan Mejzlík ◽  
Viktor Chrobok
Keyword(s):  
Clinical Practice ◽  
Middle Ear ◽  
Surgical Techniques ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
The Mean ◽  
Comparison Of The Results

Introduction: The SAMEO-ATO system established by IOOG consensus in 2018 introduces a new, complex, and unified classification of middle ear surgery. This system is generally suitable for various surgical procedures in the middle ear. The main goal of this work is to present our experience of using the new classification system in the clinical practice focusing on cholesteatoma surgery. Methods: We have retrospectively classified the group of patients who underwent surgery for chronic otitis media with cholesteatoma between 2013 and 2017. Results: We classified 142 cholesteatoma surgeries carried out on 104 patients (56 men and 48 women at the age 5–77 years, with the mean 33 years and the median 27 years) using the SAMEO-ATO classification. There were 77 primary surgeries (S1), 40 second-look surgeries (S2p) and 25 secondary surgeries for recidivism (S2r). There was a 50% (20) incidence of recurrent cholesteatoma in S2p surgeries and 76% (19) incidence of residual cholesteatoma in S2r. We have further evaluated our group of patients by each SAMEO-ATO subclassification. In the mastoid part of surgery (parameter “M”), the combination of M1a + 2a (N = 49, 34.51%) was most frequent, followed by M2c (N = 25, 17.61%), M2a (N = 20, 14.08%), M1a (N = 4, 2.82%), M2b (N = 5, 3.52%), M3a (N = 3, 2.11%) and M3b (N = 1, 0.70%). In the ossicular reconstruction (parameter “O”), the most frequent was Osd (N = 58, 40.85%), followed by Ost (N = 21, 14.79%), Oft (N = 19, 13.38%), Ofd (N = 5, 3.52%) and Osm (N = 5, 3.52%). Conclusions: The SAMEO-ATO classifies various surgical techniques of cholesteatoma removal as well as reconstruction of the ossicular chain. It allows the creation of a unified database of patients who underwent middle ear surgery and the comparison of the results of different surgery techniques among various departments. The collected data are applicable for research purposes.

Assessment of Stapes Mobility by Use of a Newly Developed Piezoelectric Ceramic Device

2000 ◽  
Vol 109 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Kiyofumi Gyo ◽  
Eiji Yumoto ◽  
Hidemitsu Sato ◽  
Naoaki Yanagihara
Keyword(s):  
Middle Ear ◽  
Piezoelectric Ceramic ◽  
Chronic Otitis Media ◽  
The Other ◽  
Middle Ear Surgery ◽  
Measuring Range ◽  
Ear Surgery ◽  
Dental Cement ◽  
Surgical Field ◽  
The Mean

A piezoelectric device was developed for assessment of stapes mobility during middle ear surgery. The device comprises a pair of ceramic bimorph elements: one for activation of the stapes and the other to pick up the vibration as an electric output, which varies in accordance with the stapes mobility, ie, the inverse of the cochlear input impedance (Zsc). The device is compact and easily manipulated even in the narrow surgical field of the ear. However, the measuring range is restricted to between 1 and 10 kHz. Measurement of Zsc was conducted with this device in 5 ears of 5 dogs. The mean magnitude of Zsc increased with frequency in the range from 1 to 10 kHz: 0.95 megohm at 1 kHz and 8.8 megohms at 10 kHz. After fixation of the stapes with dental cement, the magnitude increased to more than 10 megohms, except at 1 kHz. The results suggest that the device is useful in detecting decreases in stapes mobility in patients with chronic otitis media.

scholarly journals Microendoscopic Surgery of Middle Ear and Petrous Bone: Benefits Analysis

2020 ◽  
pp. 014556132093001 ◽  
Author(s):  
Arturo Mario Poletti ◽  
Lorenzo Salvatore Solimeno ◽  
Giovanni Cugini ◽  
Stefano Miceli ◽  
Giovanni Colombo
Keyword(s):  
Middle Ear ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Petrous Bone ◽  
Tertiary Hospital ◽  
Middle Ear Surgery ◽  
Microscopic Approach ◽  
Ear Surgery ◽  
Glomus Tympanicum ◽  
Double Technique

Objectives: Endoscopy has become routinely used in middle ear surgery. The aim of this study is to analyze where this tool may complement the traditional microscopic approach. This is a retrospective study done in single tertiary hospital. Methods: We reviewed 342 middle ear/petrous bone surgical procedures performed between 2005 and 2015. Only cases in which both microscopic and endoscope-assisted techniques were used have been included. Sixty-six patients received this double-technique surgery: 51 (77.2%) had middle ear/mastoid and petrous bone cholesteatomas (46 middle ear and mastoid and 5 acquired/congenital petrous bone cholesteatomas), 5 (7.5%) had glomus tympanicum tumors (GTT), 4 (6%) had an ossicular chain dislocation, 3 (4.5%) had purulent chronic otitis media, 2 (3%) had tympanosclerosis, and 1 (1.5%) had an ossicular chain malformation. Results: The endoscope was helpful to remove disease remnants not accessible by microscope in 41 (62%) of the cases; 37 (90%) were cholesteatomas, 3 (7%) were GTT, and only 1 (3%) was an open tympanosclerosis. In the remaining 25 (37.8%) cases, the endoscope was useful only to visualize the cavity since the microscope had already been successful in removing the entire lesion. Conclusions: The endoscopy can add valuable information and support to the usual microscope approach alone. The consensus of a single best technique does not yet exist, but the physician should choose the best modality or combination of modalities in order to cure the patient and prevent any possible complications or recurrence of the pathology.

scholarly journals Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media

2020 ◽  
Author(s):  
Susen Lailach ◽  
Theresa Langanke ◽  
Thomas Zahnert ◽  
Susan Garthus-Niegel ◽  
Marcus Neudert
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Otitis Media ◽  
Middle Ear ◽  
Short Form ◽  
Chronic Otitis Media ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Sf 36

Abstract Purpose The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). Methods This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. Results After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001). Conclusion Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.

Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery

1998 ◽  
Vol 119 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Juha-Pekka Vasama ◽  
Jyrki P. Mäkelä ◽  
Hans A. Ramsay
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Pure Tone ◽  
Conductive Hearing Loss ◽  
Adult Patients ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Pure Tone Average ◽  
The Mean ◽  
Conductive Hearing

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)

A new device for real-time peroperative monitoring of ossicular chain reconstruction during middle ear surgery

2019 ◽  
Vol 34 (4) ◽  
pp. 827-832
Author(s):  
Van Son Nguyen ◽  
Didier Rouxel ◽  
Brice Vincent ◽  
Joël Ducourneau ◽  
Cécile Parietti-Winkler
Keyword(s):  
Real Time ◽  
Middle Ear ◽  
Ossicular Chain ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
New Device ◽  
Ossicular Chain Reconstruction

Gustatory changes in patients with chronic otitis media, before and after middle-ear surgery

2012 ◽  
Vol 126 (5) ◽  
pp. 470-474 ◽  
Author(s):  
C-C Huang ◽  
C-D Lin ◽  
C-Y Wang ◽  
J-H Chen ◽  
Y-T Shiao ◽  
...  
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Middle Ear Surgery ◽  
Chorda Tympani ◽  
Chorda Tympani Nerve ◽  
Ear Surgery ◽  
Taste Testing ◽  
Gustatory Function ◽  
Before And After

AbstractObjective:We investigated gustatory changes in patients with chronic otitis media, before and after middle-ear surgery.Methods:This prospective study included 38 patients with unilateral chronic otitis media. We used taste testing solutions to evaluate each patient's taste function. Intra-operative assessments of the chorda tympani nerve were also compared and analysed.Results:Patients with chronic otitis media had significantly worse ipsilateral perception of sour, bitter and salty tastes. In patients with good intra-operative preservation of the chorda tympani nerve, there was significant improvement in gustatory function one month post-operatively, compared with the pre-operative baseline. In patients who sustained intra-operative chorda tympani nerve injury, one month post-operative gustatory function was the same as the pre-operative baseline.Conclusion:Middle-ear surgery for chronic otitis media not only treats the ear but also improves gustatory function in the majority of patients. In patients with intra-operative injury to the chorda tympani nerve, post-operative taste decline is only temporary.

scholarly journals Factors that have an influence on bone conduction thresholds changes after otosurgery in the patients operated on due to the perforation of the tympanic membrane with the preserved ossicular chain

2017 ◽  
Vol 71 (4) ◽  
pp. 26-33
Author(s):  
Maciej Wiatr ◽  
Agnieszka Wiatr ◽  
Sebastian Kocoń ◽  
Jacek Składzień
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Negative Impact ◽  
Positive Impact ◽  
Round Window ◽  
Bone Conduction ◽  
Ossicular Chain ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Study Objective

Introduction: The aim of the middle ear surgery is to eliminate abnormalities from the mucous, ensure the due airing of the postoperative cavity and reconstruct the sound-conducting system in the middle ear. Numerous reports can be found in literature on the changes to bone conduction as a consequence of middle ear surgery. Study objective: The aim of the work is to define the factors that affect bone conduction in the patients operated on due to the perforation of the tympanic membrane with the preserved and normal mobile ossicular chain. Material and method: A prospective analysis of patients operated on due to diseases of the middle ear in 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were taken into consideration. The analysis encompassed the patients who had undergone myringoplasty. The patients were divided into several groups taking into account the abnormalities of the mucous observed during otosurgery. Results: A significant improvement of bone conduction was observed in the patients with dry perforation, without other lesions in the middle ear. The appropriate pharmacological treatment before otosurgery in patients with permanent discharge from the ear resulted in significant bone conduction improvement. The elimination of granulation lesions turned out to be a positive factor for the future improvement of the function of the inner ear. Conclusions: The lack of abnormalities on the mucous of the middle ear (e.g. granulation,) and discharge has a positive impact on improvement of bone conduction after myringoplasty. Adhesions in the tympanic cavity, especially in the niche of the round window, have a negative impact on improvement of bone conduction in patients after myringoplasty.

Bioinert Ceramic Implants in Middle Ear Surgery

1981 ◽  
Vol 90 (6) ◽  
pp. 640-642 ◽  
Author(s):  
Klaus Jahnke ◽  
Dietrich Plester
Keyword(s):  
Aluminum Oxide ◽  
Middle Ear ◽  
Animal Experiments ◽  
Surgical Techniques ◽  
Middle Ear Surgery ◽  
Oxide Ceramic ◽  
Ear Surgery ◽  
Ceramic Implants ◽  
Aluminum Oxide Ceramic ◽  
Bioinert Ceramic

The suitability of different ceramic materials for reconstructive middle ear surgery was examined in extensive animal experiments. Since 1978 we have used more than 250 aluminum oxide ceramic implants for ossicular chain reconstruction. The excellent tolerance of this bioinert material was confirmed. The ease and precision with which these implants can be drilled during the operation is especially advantageous. The indications and techniques for the use of the aluminum oxide ceramic implants are described. Our short-term results stimulated the further development of bioinert ceramic implants and our surgical techniques. The special characteristics of bioactive ceramics are such that they can form a tight bond to osseous bone. They are intended for filling bone cavities (porous tricalcium phosphate ceramic) and for reconstruction of the posterior canal wall.

scholarly journals The effect of preserved stapedial superstructure on hearing improvement

2019 ◽  
Vol 73 (6) ◽  
pp. 1-5
Author(s):  
Aleksandra Boroń ◽  
Agnieszka Wiatr ◽  
Jacek Składzień ◽  
Maciej Wiatr
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
The Other ◽  
Middle Ear Surgery ◽  
Reconstruction Method ◽  
Hearing Improvement ◽  
Ear Surgery ◽  
Extent Of Damage

Introduction: Ossiculoplasty can be carried out in a number of ways, depending on the anatomical and functional conditions encountered during otosurgery and the experience of a given centre. The extent of damage to the ossicular chain determines the reconstruction method. Aim: The objective of the study was to analyse treatment effects in terms of postoperative hearing improvement in patients with chronic otitis media, with a particular emphasis on stapedial superstructure preservation. Material and method: The records of 294 consecutive patients undergoing their first ENT surgery due to chronic otitis media at the Department of Otolaryngology of Collegium Medicum, Jagiellonian University of Kraków in 2009–2013 were analysed. In order to assess the role of preserved stapedial superstructure, 96 patients were eligible for further analysis. Results: The analysis points to a significant hearing improvement after ossiculoplasty with the preserved stapedial superstructure as compared with the patients after footplate mobilisation. On the other hand, the research results point to significantly smaller hearing improvement in those patients, in whom only stapes was preserved, as compared with those, in whom a more extensive reconstruction of the ossicular chain was possible. Conclusions: The air-bone gap measured before otosurgery often fails to reflect the extent of abnormalities and cannot, therefore, be considered as the only prognostic factor for postoperative hearing improvement. Stapes preservation is crucial for hearing improvement after middle ear surgery.

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