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Postoperative surgical site infection in Cholesteatoma surgery with and without mastoid obliteration, what can we learn?

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Journal of Otology 2022年第1期17卷 25-30页

作者： F.L.J.Cals H.F.E.van der Toom R.M.Metselaar A.van Linge M.P.van der Schroeff R.J.Pauw Department of Otorhinolaryngology and Head and Neck Surgery Erasmus Medical CenterRotterdamthe Netherlands

Introduction:This study aims to describe the occurrence of postoperative complications related to Cholesteatoma surgery and to determine factors influencing the most common complication,i.***.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated Cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 Cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in Cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in Cholesteatoma surgery.

关键词： Cholesteatoma Mastoid obliteration Postoperative surgical site infection Complications Bioactive glass S53P4

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A Novel Surgery Classification for Endoscopic Approaches to Middle Ear Cholesteatoma

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Current Medical Science 2020年第1期40卷 9-17页

作者： Yu SUN En-hao WANG Jin-tao YU Gang ZHONG Li-xin ZHU-Yi WANG Niu XUN Hong YU Wen ZHOU Zhen XIE Kun ZHANG Guo-run FAN Yi ZHONG Hong-jun XIAO Wei-jia KONG Department of Otorhinolaryngology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

This study aimed to develop a novel surgery classification for an endoscopic approach to middle ear Cholesteatoma.We retrospectively analyzed the surgical approaches and outcomes of patients with middle ear Cholesteatoma.Middle ear Cholesteatoma surgeries were divided into four types and two special types as follows:type I,attic retraction pocket,which only requires tympanostomy tube placement or retraction pocket resection and cartilage reconstruction;typeⅡ,Cholesteatoma which is limited to the attic or in which endoscopy can confirm complete removal of mastoid Cholesteatoma lesions,including type Ⅱa,requiring only use of a curette,and type Ⅱ b,requiring use of an electric drill or chisel;type Ⅲ,Cholesteatoma not limited to the attic,in which endoscopy cannot confirm complete removal of mastoid Cholesteatoma lesions,requiring the combined use of endoscope and microscope to perform endoscopic tympanoplasty and"Canal Wall Up"mastoidectomy;type Ⅳ,extensive involvement of mastoid cavity Cholesteatoma lesions and/or cases with a potential risk of complications,removal of which can only be performed under a microscope for"Canal Wall Down"mastoidectomy.In addition,there were two special types:"difficult external auditory canal"and congenital Cholesteatoma in children.In our system,type I and type U middle ear Cholesteatoma surgery was completely performed under an endoscope alone.However,estimating the extent of the lesions,determining the choice of mastoid opening and reestablishing ventilation are the key points for an endoscopic approach to middle ear Cholesteatoma.The classification of endoscopic middle ear Cholesteatoma surgery may benefit the selection of surgical indications.

关键词： otologic surgical procedure endoscopy Cholesteatoma middle ear

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Endoscopic Management of Pediatric Cholesteatoma

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Journal of Otology 2020年第1期15卷 17-26页

作者： Peter J.Ryan Nirmal P.Patel Department of Otolaryngology and Head and Neck Surgery Royal North Shore HospitalSt LeonardsNSWAustralia Kolling Deafness Research Centre Macquarie University and University of SydneyNSWAustralia

Pediatric Cholesteatoma occurs in one of two forms:congenital Cholesteatoma,developing from embryonic epidermal cell rests or acquired Cholesteatoma,associated with a focal defect in the tympanic membrane.This disease has been traditionally managed with the operating microscope,often requiring mastoidectomy for adequate visualization of and access to the middle ear and mastoid cavities.Recently,advances in endoscopic equipment have enabled otologists to manage most cases of pediatric Cholesteatoma via a minimally-invasive,transcanal endoscopic approach.This review discusses the current literature relating to the etiopathogenesis,assessment and endoscopic management of pediatric Cholesteatoma.Early outcomes of endoscopic treatment,emerging trends and technologies are also reviewed.

关键词： Cholesteatoma Pediatric Endoscopic Minimally-invasive Middle ear Mastoid

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Role of endoscopy in surgical management of Cholesteatoma:A systematic review

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Journal of Otology 2020年第4期15卷 166-170页

作者： Bhavika Verma Yogesh G.Dabholkar Department of ENT School of MedicineD.Y.Patil UniversityNavi MumbaiIndia

Endoscopes are increasingly being used in Cholesteatoma surgeries either as an adjunct to microscopes or sometimes exclusively.Their role at present is more as adjunct to microscope which still remains the work-horse for mastoidectomy.However,as endoscopy and endoscopic instruments are increasingly getting refined,role of endoscopy in management of Cholesteatoma is continuously being appraised with progressively newer studies.This review aims to assess outcomes of several studies in which endoscopic techniques were used in Cholesteatoma surgery and recognize common trends.An extensive review of literature on this theme was performed.Sixteen studies comprising of 1685 patients treated endoscopically either exclusively or in combination with microscope were included.Intra-operatively,in 267(15.82%)cases,residual Cholesteatoma was identified by endoscope in hidden areas after completion of surgery with microscope.On follow-up,recidivism was identified in 108 cases(6.4%)in second look procedures.Common sites of recurrence were hidden areas like sinus tympani.This review while acknowledging the value of microscope,highlights the merit of endoscope usage in Cholesteatoma surgery and its role in reducing recurrence.

关键词： Endoscopic ear surgery Systematic review Adjunctive endoscopy Cholesteatoma Mastoidectomy Recurrence

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Application of high resolution computer tomography in external ear canal Cholesteatoma diagnosis

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Journal of Otology 2018年第1期13卷 25-28页

作者： Yubin Chen Peng Li Department of Otolaryngology Head and Neck Surgery The Third Affiliated Hospital of Sun Yat-Sen University

Objective: To evaluate High Resolution Computer Tomography(HRCT) in the diagnosis of external ear canal Cholesteatoma.Methods: In this retrospective study, HRCTs of 27 patients with external ear canal Cholesteatoma were reviewed. The changes in the external ear canal, tympanic membrane(TM), scutum, tympanum and mastoid were measured and categorized.Results: Fourteen patients showed no or mild destruction in the external ear canal(stage Ⅰ group). Eight patients had obvious enlargement in the external ear canal(stage Ⅱ group) but showed limited destructions of the mastoid bone and no damage of the tympanums. Five patients had serious destruction of the mastoid bone and damage of the tympanum(stage Ⅲ group). All patients in the stage Ⅲ group showed a compression of manubriums and TMs, with 3 having damages on ossicular chain. Bone destruction of the vertical section of facial nerve canal was discovered in one case in the stage Ⅲ group.Conclusion: HRCT can provide detail information about the extent of external ear canal Cholesteatoma. Such information can be used to identify special situations with serious complications and to differentiate external ear canal Cholesteatoma from middle ear Cholesteatoma.

关键词： External ear canal Cholesteatoma Computer tomography

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Retraction pocket excision with cartilage grafting as a preventive surgery for Cholesteatoma

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Journal of Otology 2017年第3期12卷 112-116页

作者： Comacchio Francesco Mion Marta Pedruzzi Barbara Institute of Otolaryngology Department of Neurosciences Padova University Via Giustiniani 2 35121 Padova Italy Institute of Otolaryngology Ospedali Riuniti Padova Sud Via Albere 30 35043 Monselice Italy

Aims: The goal of the present study is to summarize our experience on surgical management of retraction pockets(RP) as a preventive tool against Cholesteatomas.Methods:Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years(from 1 to 17 years). The sample presented a mean age of 47.56 + 19.11 years(from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10(40%) underwent tympanoplasty(TPL) type Ⅰ, 14(56%) TPL type Ⅱ and 1(4%) TPL type Ⅴ.Results: Eleven ears(44%) showed Cholesteatoma: all these cases were stage Ⅲ according to Charachon staging, and stage Ⅳ or Ⅴ according to Gersdorff classification. Twelve patients(48%) showed erosion of the ossicular chain. Of these, five were associated with Cholesteatoma and seven only with retraction. The recurrence rate of Cholesteatoma was 12%. None of the patients with a stage Ⅱ or Ⅲ RP(according to Gersdorff classification) developed Cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of Cholesteatoma of 28%.Conclusions: Surgical treatment of stages Ⅱ and Ⅲ RP is an effective tool to prevent Cholesteatoma formation. The presence of keratin accumulation and Cholesteatoma at the RP(stages Ⅳ and Ⅴ, according to Gersdorff) are the real predictors of poor prognosis.

关键词： Cartilage Cholesteatoma Graft Pockets Retraction

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Label-free visualization of Cholesteatoma in the mastoid and tympanic membrane using CARS microscopy

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Journal of Otology 2016年第3期11卷 127-133页

作者： Jing Zou Antti Isomaki Timo Hirvonen Antti Aarnisalo Jussi Jero Ilmari Pyykko Department of Otolaryngology-Head and Neck Surgery Center for Otolaryngology-Head&Neck Surgery of Chinese PLAChanghai HospitalSecond Military Medical University Hearing and Balance Research Unit Field of Oto-laryngologySchool of MedicineUniversity of Tampere Biomedicum Imaging Unit Faculty of MedicineUniversity of Helsinki Department of Otorhinolaryngology-Head and Neck Surgery Helsinki University Central Hospital

Objective:The present study aimed to evaluate the possibility of using coherent anti-Stokes Raman spectroscopy（CARS） microscopy to determine the specific molecular morphology of Cholesteatoma by detecting the natural vibrational contrast of the chemical bonds without any staining.Materials and methods:Specimens from the mastoid and tympanic membrane with and without Cholesteatoma were analyzed using CARS microscopy,two-photon excited fluorescence（TPEF） microscopy,and the second harmonic generation（SHG） microscopy.Results:In Cholesteatoma tissues from the mastoid,a strong resonant signal at 2845 cm;was observed by CARS,which indicated the detection of the CH;hydro-carbon lipid bonds that do not generate visible signals at 2940 cm;suggestive of CH;bonds in amino acids.A strong resonant signal at 2940 cm;appeared in an area of the same specimen,which also generated abundant signals by TPEF and SHG microscopy at 817 nm,which was suggestive of collagen.In the tympanic membrane specimen with Cholesteatoma,a strong resonant signal with corrugated morphology was detected,which indicated the presence of lipids.A strong signal was detected in the tympanic membrane with chronic otitis media using TPEF/SHG at 817 nm,which indicated collagen enrichment.The CARS and TPEF/SHG images were in accordance with the histology results.Conclusion:These results suggest the need to develop a novel CARS microendoscope that can be used in combination with TPEF/SHG to distinguish Cholesteatoma from inflammatory tissues.

关键词： Cholesteatoma Imaging Label-free Raman spectroscopy High resolution

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Endoscopic transcanal modified canal-wall-down mastoidectomy for Cholesteatoma

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2017年第3期3卷 153-159页

作者： Hamed Sajjadi Stanford University School of Medicine Department of Otolaryngology-HNS USA

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 al lows 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.

关键词： Cholesteatoma Inside-out technique Attico-antrotomy Sclerotic mastoid Attic obstruction Middle ear Cholesteatoma DWI MRI Propeller MRI for Cholesteatoma Ossicular chain reconstruction Cartilage repair of attic

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Modification of closed tympanoplasty in middle ear Cholesteatoma

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Chinese Medical Journal 2010年第4期123卷 447-451页

作者： ZHANG Zhi-gang LIU Xiang CHEN Sui-jun CHEN Bin ZHENG Yi-qing Department of Otorhinolaryngology Head and Neck Surgery Second Affiliated Hospital of Sun Yat-sen University Guangzhou Guangdong 510120 China

Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear Cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear Cholesteatoma. Methods Eighty-three patients were recruited in this study based on the following two criteria： each patient had middle ear Cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis （TORP） or partial ossicular replacement prosthesis （PORP） and membrane repair with conchal cartilage-perichondral complex. Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with Cholesteatoma recurrence （6.02%）. Function tests after one postoperative year exhibited an improvement of pure tone audiometry （PTA） in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement. Conclusions The modified closed tympanoplasty procedure for middle ear Cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.

关键词： mastoidectomy tympanoplasty Cholesteatoma cartilage middle ear

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Diffusion weighted imaging for the detection and evaluation of Cholesteatoma

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World Journal of Radiology 2017年第5期9卷 217-222页

作者： Benjamin Henninger Christian Kremser Department of Radiology Medical University of Innsbruck6020 InnsbruckAustria

Cholesteatoma is a collection of keratinous debris and stratified squamous epithelium.It is trapped in the middle ear and can lead to bony erosion.The disease is treated surgically often followed by a second-look procedure to check for residual tissue or recurrence.Cholesteatoma has specific signal-intensity characteristics on magnetic resonance imaging with very high signal intensity on diffusion weighted imaging(DWI).Various DWI techniques exist:Echo-planar imaging(EPI)-based and non-EPI-based techniques as well as new approaches like multi-shot EPI DWI.This article summarizes all techniques,discusses the significance in detecting Cholesteatoma and mentions actual studies.Further recommendations for daily clinical practise are provided.

关键词： Cholesteatoma Diffusion weighted imaging Computed tomography Magnetic resonance imaging Echo-planar imaging Non-echo-planar imaging

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