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Pre-operative high resolution CT temporal bone image. A. high resolution CT-temporal bone image showing homogenous soft tissue opacity involving mesotympanum, epitympanum, retrotympanum with posterior canal wall erosion of left ear; B. high resolution CT-temporal bone image showing homogenous soft tissue opacity involving mesotympanum, epitympanum with signs of previous mastoidectomy of right ear
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Objective
Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma. At present transcanal endoscopic ear surgery (TEES) is being used as a minimally invasive alternative for microscopic approach. We aim to evaluate the feasibility, structural, functional and quality of l...
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Introduction The treatment of cholesteatoma is generally surgical, and the major obstacle is the high prevalence of recidivism. The endoscopic ear surgery technique is proposed to minimize this problem.
Objectives To utilize endoscopes to visualize and manipulate cholesteatoma residues after microscopic removal
Methods Cross-sectional study. Thirty...
We have developed a novel instrument which is a drill burr protection sheath with an inbuilt suction-irrigation system for endoscopic ear surgery. It allows simultaneous suction and irrigation. It is a metallic attachment onto the mastoid drill handpiece. It provides protection for the endoscope as well as the external auditory skin during transcan...
IntroductionLabyrinthine fistula is one of the most frequent complications of cholesteatoma (CHO), occurring in about 8% of cases in the literature. In about 90% of cases, it is located at the level of the lateral semicircular canal, and its clinical manifestation includes vertigo, nystagmus and positive Hennebert and Tullio signs. The management o...
Citations
... Additionally, the initial search yielded one eligible study that could not be retrieved with the updated search (43). Together, this resulted in 16 unique fulltext articles (3,8,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) for inclusion in the systematic review ( Figure 1). Table 1 represents a detailed overview of the relevant characteristics of the included studies. ...
... One questionnaire for general chronic middle ear diseases (CES) was used and three COM-specific questionnaires (COMQ-12, ZCMEI-21, and COMOT-15). CES (3,(35)(36)(37)(38) and COMOT-15 (8, 31-34) were used in five different studies, and the ZCMEI-21 (31, 39, 40) and COMQ-12 (42)(43)(44) in three studies. Furthermore, three general HRQoL questionnaires were used: SF-36 (8,31,43), SF-12V2 (38), and Euro-Qol-5D-5L (42). ...
... CES (3,(35)(36)(37)(38) and COMOT-15 (8, 31-34) were used in five different studies, and the ZCMEI-21 (31, 39, 40) and COMQ-12 (42)(43)(44) in three studies. Furthermore, three general HRQoL questionnaires were used: SF-36 (8,31,43), SF-12V2 (38), and Euro-Qol-5D-5L (42). A hearing-specific QoL questionnaire (HHIA) was used once (42). ...
Objective
This systematic review aims to describe the impact of otologic surgery as a treatment for chronic otitis media (COM) on the Health-Related Quality of Life (HRQoL) of adult patients.
Methods
A literature search was performed in PubMed, Scopus, Embase, and Web of Science until May 2023. Prospective studies including adult patients with COM (cholesteatoma) who underwent canal wall up mastoidectomy, canal wall down mastoidectomy, or tympanoplasty without mastoidectomy, with pre- and postoperative HRQoL measurements, were considered eligible. Questionnaire validation studies were excluded. The risk of bias and study quality were evaluated with a Quality Assessment Tool (for before-after studies with no control group). To assess the change in HRQoL, pre- and postoperative HRQoL values and absolute changes were extracted, synthesized, and presented in tables. Standardized mean differences (SMD) were calculated to enhance comparisons.
Results
Of the 720 studies identified, 16 met the inclusion criteria of this review. Different questionnaires were used throughout the studies. The CES and COMOT-15 were used in five studies and the ZCMEI-21 and COMQ-12 in three studies. All studies indicated statistically significant improvement in HRQoL from pre- to postoperative, measured with disease-specific HRQoL questionnaires. General HRQoL questionnaires did not show significant improvement. Calculated SMDs ranged from 0.24 to 6.99.
Discussion and conclusion
Included studies had low (n = 10) to high (n = 6) risk of bias and poor (n = 4), fair (n = 7) or good (n = 5) study quality. Surgical treatment positively impacts the HRQoL of adult COM patients with and without cholesteatoma. However, the clinical relevance of the reported changes is unknown due to the lack of minimal clinically important differences (MCID) or cut-off values in each questionnaire. Therefore, further research regarding the MCIDs of each questionnaire is needed. Future research should also report preoperative chief symptoms and indications for surgery to improve individual patient counseling.
Introduction: The primary goal of cholesteatoma surgery is to
eradicate it from the middle ear cleft. However, due to linear
axis of illumination of the microscope, in some of the recesses
or hidden areas in middle ear are not visualised. To overcome
this, many studies have been done on the complimentary use of
endoscopes in visualising these hidden areas.
Aim: To assess the outcome of complimentary use of endoscopes
in addition to microscope on improved access to hidden areas in
the middle ear and resultant cholesteatoma clearance.
Materials and Methods: In this systematic review, literature
search was conducted using the keywords both manually and
electronically in PubMed, Google scholar and Directory of Open
Access Journals for articles published till December 2021 at
ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India.
The primary inclusion criteria used was all full text original, both
prospective and retrospective, articles in which endoscopes were
used as an adjunct to microscope for cholesteatoma clearance
from middle ear cleft. Retrieved articles were reviewed by two
independent authors for their eligibility for inclusion in the study.
The selected original papers were analysed. Data was entered in
Microsoft Excel 2007 and analysed for descriptive statistics like
frequency and proportions.
Results: A total of 48 studies were identified initially. After
removing duplicates, screening was done for title, abstracts
and full text retrieval to check for inclusion criteria being met.
Six studies were found using complimentary endoscopes for
cholesteatoma surgery and were analysed. Of these, four were
prospective and two were retrospective studies. Total 604
patients underwent endoscopic examination after microscopic
clearance. Residual cholesteatoma was seen in 105 patients
(17%), which were cleared with endoscopic assistance.
Conclusion: Complimentary endoscopy detects residual
cholesteatoma in significant number of cases during primary
cholesteatoma surgery. In cholesteatoma surgery, they are
predominantly used as observational tools.
Objective
Transcanal endoscopic ear surgery is hypothesized to result in less postoperative pain when compared to nonendoscopic techniques due to its minimally invasive nature. In this systematic literature review, we aim to summarize and evaluate the evidence surrounding postoperative pain control and analgesic utilization after transcanal endoscopic ear surgery.
Databases reviewed
PubMed, EMBASE, and Cochrane.
Methods
A systematic literature search was performed using standardized methodology. Computerized and manual searches were performed to identify studies that evaluated postoperative pain outcomes following endoscopic ear surgery. Only studies that met predetermined criteria were selected and evaluated for quality and bias. Extracted data included demographics, pain scores, analgesic administered as well as the diagnosis and type of surgery undertaken. Exclusion criteria included letters/commentaries and reviews, lack of pain outcome data and studies not concerning endoscopic ear surgery.
Results
The systematic literature review included 24 studies. Seven were RCTs, 10 were prospective and 7 were retrospective observational studies. A total of 1859 patients were evaluated for surgical approach and postoperative pain levels and analgesic use. Due to the lack of sufficient reporting of the data, a meta-analysis was not applicable. In the qualitative synthesis for the primary outcome, weighted pooled analysis showed that there was a slight reduction in postoperative pain after transcanal endoscopic ear surgery. Based on the Cochrane risk of bias tool, the quality for the finding is low.
Conclusion
There is a small reduction in postoperative pain after transcanal endoscopic ear surgery when compared to nonendoscopic approaches, however, the clinical significance of this reduction is unclear. The evidence was from studies of only low to moderate quality.
Objectives:
We aimed to compare clinical outcomes including hearing improvement and cholesteatoma recurrence between endoscopic and conventional microscopic surgeries in patients with attic cholesteatoma.
Methods:
We collected data from patients with attic cholesteatoma who were treated using endoscopic (10 patients) and microscopic (10 patients) approaches by a single surgeon. The data were retrospectively reviewed for patient characteristics, intraoperative findings, hearing levels, and follow-up clinical status. Recurrence of the cholesteatoma, improvement of hearing, and operation time were evaluated.
Results:
Ossiculoplasty was performed in four patients in the endoscopic group and two patients in the microscopic group. Lempert endaural incision II was used in all the patients in the microscopic group, whereas Lempert I incision was used in all the patients in the endoscopic approach group. There were no significant differences between the two groups regarding hearing improvement and operating time. And, there were no recurrences during the follow-up period in both groups.
Conclusion:
The endoscopic approach for the management of attic cholesteatoma is as useful as the microscopic approach.
