Chronic Ear Surgery Research Articles

Patient satisfaction with endoscopic ear surgery technique: a comparative study with the postauricular incision microscopic technique

BackgroundEndoscopic ear surgery has numerous benefits, such as the capacity to obtain high-resolution pictures and visualize normally inaccessible locations such as the retrotympanum, sinus tympani, and facial recess. These areas are generally difficult to access with traditional microscopic techniques. Endoscopic ear surgery reduces operating time when performed by skilled surgeons, without the need for a postauricular incision wound.An essential aspect to consider when evaluating the effects of any procedure on individual satisfaction is the assessment of health-associated quality of life. It is a tool used for subjective assessment, which is regarded as a reliable measure of the satisfaction perceived—whether physically or mentally—resulting from a certain procedure.The goal of this study was to identify the benefits of middle ear surgery when done endoscopically compared to postauricular microscopic techniques in middle ear surgery. This was achieved by evaluating and comparing the level of satisfaction among patients who underwent either microscopic or endoscopic ear surgery.MethodsThe Chronic Ear Surgery Survey (CESS), a 13-point Likert scale survey designed specifically for assessing outcomes of surgery for chronic middle ear disease, was implemented to measure patient satisfaction. The survey comprises three subscales. We performed a retrospective study at the Otorhinolaryngology Department, Cairo University, Egypt. The study encompassed individuals who underwent surgery on the middle ear between March 2018 and September 2021.The patients were scheduled into two categories according to the technique of surgery (whether endoscopic or microscopic) in order to assess postoperative satisfaction using the Chronic Ear Surgery Survey (CESS).ResultsOur research findings demonstrated a statistically significant difference between the two categories in terms of the overall scores and all subscale scores of the Chronic Ear Surgery Survey (CESS), with patients who had middle ear surgery endoscopically (EES) showing better outcomes.ConclusionsIdentifying the elements that are strongly associated with subjective outcomes can assist surgeons in identifying patients who are more likely to have poorer satisfaction. This knowledge can be valuable in preoperative counseling. Endoscopic ear surgery (EES) seems to have a higher level of cosmetic acceptability, especially in terms of enhancing the socially related aspects of a patient's pleasure. This work thus supports the ongoing integration of endoscope utilization in otological surgical procedures.

Risk of hearing loss in the opposite ear after tympanomastoidectomy.

The definitive treatment for chronic suppurative otitis media is surgery. Surgical technique and procedure varies according to individual case findings and pathology and may require mastoidectomies in which the canal wall is preserved or lowered to eradicate disease from mastoid air cells. Surgical treatment of chronic middle ear disease carries a risk of damage to the inner ear. The aim of this study was to investigate whether the noise produced by the tour system following chronic ear surgery causes sensorineural hearing loss, a condition for which not many studies have been published in the literature. The study consisted of a total of 49 patients with type I, type II and type III canal wall preservation and 62 patients with tympanoplasty with canal wall preservation and lowering. Bone and air thresholds were compared before and after middle ear surgery. Changes in bone and air thresholds were compared according to the type of tympanoplasty. In the ICW-I, ICW-II and ICW-III tympanoplasties, and in the ICW and CWD tympanoplasties, the preoperative and postoperative values of the opposite ear hearing measurements were performed, and did not differ according to the type of surgery. There is no correlation drilling duration and hearing for the opposite ear. The prevention of postoperative sensorineural hearing loss depends on multiple factors, and assessing the magnitude of hearing loss in relation to these factors is important in determining the success of the surgery.

Efficacy of Otoendoscopy for Residual Cholesteatoma Detection During Microscopic Chronic Ear Surgery.

The aim of this article is to determine the efficacy of otoendoscopy during microscopic cholesteatoma surgery on residual cholesteatoma rates postoperatively. The medical records of patients (aged 4-90) with primary acquired cholesteatoma who underwent microscopic cholesteatoma surgery (exclusively transcanal approach or canal wall-up tympano-mastoidectomy) with subsequent otoendoscopic examination (80 ears) for intraoperative cholesteatoma residues were retrospectively reviewed. All cases with mixed microscopic/endoscopic, fully endoscopic, or fully microscopic dissection were excluded, as well as cases where a canal wall-down technique was used. After microscopic cholesteatoma removal, the otoendoscope was used to inspect the middle ear recesses for intraoperative cholesteatoma residues. The intra- and postoperative cholesteatoma residue rate were evaluated. On endoscopic examination, intraoperative cholesteatoma residues were encountered in 24 patients (30%). A total of 30 foci were detected. Most of them were found in the superior retrotympanum (15 foci). In 9 cases an antral remnant guided the surgeon to convert to a canal wall up tympanomastoidectomy. During the postoperative follow-up period, residual cholesteatoma was detected on postoperative magnetic resonance imaging in 6 patients (7.5%). Adding an otoendoscopic examination to microscopic cholesteatoma surgery reduced the postoperative cholesteatoma residues rate (odds ratio=0.16). A negative otoendoscopic examination led to a cholesteatoma residue-free follow-up period in 95% of cases(NPV=0.95). Otoendoscopy is effective in identifying intraoperative cholesteatoma residues after microscopic cholesteatoma surgery. It reduces the postoperative cholesteatoma residue rate, and a negative otoendoscopic examination increases the likelihood of a cholesteatoma residue-free follow-up.

Impact of Intraoperative Findings on Hearing in Revision Ear Surgery.

Hearing results after chronic ear surgery encompass recurrence, localization and extent of cholesteatoma, type of surgery, ossiculoplasty methods, but rarely interpret intraoperative findings. This study aimed to analyze the impact of intraoperative findings in revision tympanomastoidectomy in predicting postoperative hearing. This was a retrospective non-randomized cohort of 101 patients treated for recurrent chronic otitis media by tympanomastoidectomy. The patients' demographics, localizations of disease recurrence and perioperative hearing results were analyzed. Logistic regression showed that presence of tympanic perforation (p=0.036), ossicular chain damage (p=0.006), were negatively associated with improved hearing postoperatively. Attic cholesteatoma was associated with better postoperative hearing (p=0.045). Presence of tympanic perforation (p=0.050), alongside perifacial localization of imflammation (p=0.021) and ossicle destruction (p=0.013) were associated with worse postoperative hearing results. Multivariate analysis confirmed that tympanic perforation (p=0.040, F=4.401), and ossicular chain involvement (p=0.025, F=5.249), were consistent negative predictors of hearing improvement, while postoperative deterioration of hearing was associated with tympanic perforation (p=0.038, F=4.465) and facial nerve dehiscence (p=0.045, F=4.160). Comparison of postoperative revision tympanomastoidectomy hearing outcomes revealed significant positive reductions in air-bone gap values, primarily at low and mid frequencies. Postoperative hearing results at high frequencies are not affected by revision surgery.

Projected Cost Simulation in Chronic Ear Surgery: Cost in Chronic Ear Surgery.

To examine the projected healthcare costs of intact canal wall (ICW) and canal wall down (CWD) tympanomastoidectomy surgery and associated clinic follow-up visits in the management of chronic ear disease. A review of literature was performed to analyze the cholesteatoma recidivism rates of ICW and CWD tympanomastoidectomy. Projected Medicare cost simulation applied to representative samples of patients undergoing otologic surgery and follow-up clinic appointments projected over 15 years with an annual 25% cholesteatoma recidivism rate. Tertiary academic center. Simulated patient population status postchronic ear surgery and representative follow-up clinic visits with or without in-office mastoid debridement procedures. Therapeutic and rehabilitative. Healthcare cost. Simulation of cost for chronic ear surgery with follow-up visits produced a higher mean cost for the ICW group compared with the CWD group at year 1 ($9112.06 versus $4954.16). However, CWD patients accumulate cost over time due to routine mastoid debridements. The accumulated costs for the CWD group surpassed the ICW group at 12.54 (CI: 12.02-13.11) years. Using a projected cost analysis model, intact canal wall tympanomastoidectomy incurs a larger upfront cost than the canal wall down technique. However, long-term mastoid cavity maintenance costs accumulate to surpass the intact canal wall group at 12.54 years.

The Clinical Implications of Simultaneous Bilateral Chronic Ear Surgery for Patients with Asymmetric Hearing

Background and Objectives Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically.Results For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results.Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

Reducing Postoperative Call Volume Through Verbal Preoperative Education.

To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center. Quality improvement initiative. A single-academic tertiary referral center. One hundred and ten patients who underwent chronic ear surgery in March to May 2018. Preoperative counseling over the phone 1 week before surgery. Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course. There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438). Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.

Endoscopic transtympanic Eustachian tube dilatation: An overview of evaluation methods and dilatation technique.

Endoscopic technique in patients undergoing chronic ear surgery allows visualization of protympanic (proximal) segment of the Eustachian tube (ET). The proximal cartilaginous ET is a common site of anatomical Obstruction in chronic otitis media and it is this proximal end of ET that is being observed, instrumented and dilated with transtympanic methods. The aim of this article is to discuss our approach to the assessment of the Eustachian tube using opening pressure measurement, endoscopic assessment of the protympanic segment of ET and Valsalva CT. And also to discuss detailed technique of transtympanic Eustachian tube dilatation.

Symptom: Dizziness with Ear Pressure

Symptom: Dizziness with Ear Pressure

Feasibility and Safety of Transtympanic Balloon Dilatation of Eustachian Tube.

Assess safety and feasibility of transtympanic dilatation of proximal (tympanic-end) of the cartilaginous segment of the Eustachian tube in patients undergoing surgery for chronic ear disease. Case series. Tertiary care hospital. We reviewed the charts of 40 consecutive patients undergoing chronic ear surgery in our practice with manometric evidence of obstruction who underwent attempted transtympanic dilatation of proximal (tympanic-end) segment of the Eustachian tube. A range of outcome measures were reported that included pre and postdilatation opening pressure measurement of the Eustachian tube, closure of perforation, audiometric data, and complications. Dilatation of proximal (tympanic-end) of the cartilaginous segment of the Eustachian tube was technically feasible in 37 of 40 patients (93%). Postdilatation inspection of protympanum showed increased aperture in all dilated tubes. Opening pressure of Eustachian tube declined in 36 of 37 patients (97%). Residual perforation was evident in 5 of 40 patients (12%). No facial nerve or carotid complications were observed. Two patients had severe dizziness (5%) with one patient sustaining severe cochlear loss. Transtympanic dilatation increases the patency of the Eustachian tube immediately after instrumentation. No carotid complications were observed. Continuous endoscopic control is essential to avoid subluxation of stapes. Further study of this technique is warranted to identify its role, if any, in chronic ear surgery.

Endoscopic and minimally-invasive ear surgery: A path to better outcomes.

The development of endoscopic ear surgery techniques promises to change the way we approach ear surgery. In this review paper, we explore the current evidence, seek to determine the advantages of endoscopic ear surgery, and see if these advantages are both measureable and meaningful. The wide field of view of the endoscope allows the surgeon to better visualize the various recesses of the middle ear cleft. Endoscopes make it possible to address the target pathology transcanal, while minimizing dissection or normal tissue done purely for exposure, leading to the evolution of minimally-invasive ear surgery and reducing morbidity. When used in chronic ear surgery, endoscopy appears to have the potential to significantly reduce cholesteatoma recidivism rates. Using endoscopes as an adjunct can increase the surgeon's confidence in total cholesteatoma removal. By doing so, endoscopes reduce the need to reopen the mastoid during second-look surgery, help preserve the canal wall, or even change post-cholesteatoma follow-up protocols by channeling more patients away from a planned second-look.

Microbiomes of the normal middle ear and ears with chronic otitis media.

The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media. Prospective multicenter cohort study. All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan). In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears. The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation. 2b. Laryngoscope, 127:E371-E377, 2017.

The effects of smoking on Eustachian tube function and chronic ear surgery

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Transtympanic dilatation of the eustachian tube during chronic ear surgery

Conclusion: Evaluation of the protympanic segment of the eustachian tube is feasible during chronic ear surgery. Balloon dilatation of that segment yields a bigger aperture. Objective: To evaluate the feasibility of visualization and balloon dilatation of the protympanic segment of the eustachian tube during chronic ear surgery. Methods: This study was carried out on a consecutive case series. All patients undergoing surgical treatment for cholesteatoma or tympanic membrane perforation over a 6-month period of time at a tertiary hospital were evaluated intraoperatively for the ability to visualize the protympanic segment of the eustachian tube, perform balloon dilatation, and then perform visual inspection of the effect of dilatation. Results: A total of 21 chronic ear procedures were performed; visualization of the protympanic segment was feasible in 12 ears, obstruction was identified in 7 ears, and dilatation was undertaken. Immediate assessment showed increased aperture of the tube in all patients when compared with predilatation findings.

Contemporary Changes with the Use of Facial Nerve Monitoring in Chronic Ear Surgery

There is a growing trend for the routine use of the facial nerve monitor (FNM) in chronic ear surgery. We aimed to examine current patterns in the use of FNMs in chronic ear surgery. Descriptive design (survey). Academic health center. A 10-question survey was designed to identify level of training, scope of practice, specific otologic surgeries where monitoring was most used, and the opinion of respondents regarding the use of FNMs as standard of care for chronic and/or middle ear surgery. A randomized list of 2000 board-certified members of the American Academy of Otolaryngology-Head and Neck Surgery was generated. One thousand subjects received a mailed survey with a self-addressed return envelope and 1000 subjects received an emailed survey through Surveymonkey.com. There were 359 (36%) surveys returned by mail and 258 (26%) surveys returned electronically. Forty-three percent of respondents were in private practice, and 31% were fellowship trained in otology/neurotology. Sixty-five percent used a FNM in their training and 95% had regular access to a FNM. Revision mastoid surgery, cholesteatoma, canal wall down mastoidectomy, and facial recess approach were the settings where a FNM was most used. Forty-nine percent of respondents felt that a FNM should be used as the standard of care in chronic ear surgery; this represents an increase from 32% in a similar study done approximately 10 years ago. There is a growing trend for routine facial nerve monitoring in the setting of chronic ear surgery.

Contemporary Management of Chronic Ear Disease

Program Description: This miniseminar will discuss various aspects of the management of chronic ear disease, including ossicular chain reconstruction, cartilage and pediatric tympanoplasty, the role of endoscopes, and the management of chronic otitis media without cholesteatoma. Time permitting, a discussion on the management of labyrinthine fistulas will also be presented. A case based approach to these topics will be presented by the moderators to the panel members. Educational Objectives: 1) Describe ossicular chain reconstruction, including approaches, staging, and prosthesis selection (including autologous materials). 2) Recognize indications and methods of cartilage tympanoplasty and pediatric tympanoplasty. 3) Manage chronic otitis media without cholesteatoma and the role of endoscopes in chronic ear surgery.

Round window vibroplasty in chronic ear surgery: comparison with conventional hearing rehabilitation

Conclusion: Functional hearing results with round window vibroplasty in chronically disabled middle ears were comparable and, at high frequencies, superior to the results achieved with previously used conventional hearing aids even after extended surgery. Soft tissue transfer appears to be more important than floating mass transducer (FMT) alignment with the round window membrane (RWM) for efficient coupling or sonoinversion. Objectives: To evaluate the functional hearing results of an active middle ear implant (AMEI) to the round window niche (RWN). The results were compared with previously used conventional hearing aids. The position of the FMT was determined by cone-beam computed tomography (CBCT). Methods: This was a prospective cohort study carried out in a tertiary referral center. Seven patients with severe middle ear disease were implanted with an AMEI with round window application. The postoperative hearing outcome was compared with preoperative hearing using unaided and conventionally aided conditions. The results were correlated with the physical/geometric relation of the FMT to the RWM as determined with CBCT. Results: Dislocation of the FMT was not observed. One patient was re-implanted due to accidental damage to the electrode. In all patients, the pertinent functional hearing results were achieved and were comparable to previous rehabilitation results.

Is facial nerve integrity monitoring of value in chronic ear surgery?

Is facial nerve integrity monitoring of value in chronic ear surgery?

Long-term hearing result using Kurz titanium ossicular implants

Titanium implants in middle ear surgery were introduced in the late 90s and are now frequently used in middle ear surgery. However, long-term studies of patient outcome are few and have only been published in subgroups of patients. We report the long-term effect of titanium middle ear implants for ossicular reconstruction in chronic ear disease investigated in a Norwegian tertiary otological referral centre. Retrospective chart reviews were performed for procedures involving 76 titanium implants between 2000 and 2007. All patients who underwent surgery using the Kurz Vario titanium implant were included in the study. Audiological parameters using four frequencies, 0.5, 1, 2, and 3 kHz, according to AAO-HNS guidelines, was assessed pre and postoperatively. Otosurgical procedures, complications, revisions, and extrusion rates were analyzed. The study had no dropouts. The partial ossicular replacement prosthesis (PORP) was used in 44 procedures and the total ossicular replacement prosthesis (TORP) in 32 procedures, respectively. Mean follow-up was 5.2 years (62 months). The ossiculoplasties were performed as staging procedures or in combination with other chronic ear surgery. The same surgeon performed all the procedures. A postoperative air-bone gap of ≤ 20 dB was obtained in 74 % of the patients, 82 % for the Bell (PORP) prosthesis, and 63 % for the Arial (TORP) prosthesis. The extrusion rate was 5 %. We conclude that titanium ossicular implants give stable and excellent long-term hearing results.

Sensation recovery of auricle following chronic ear surgery by retroauricular incision

The aim of this prospective analysis was to objectify and quantify the sensory loss in the auricular area that occurs following surgery for chronic otitis media or cholesteatoma, and to assess the exact recovery time of the auricular sensation. Till now, no study has yet been conducted on the sensory loss that is developed after retroauricular incision is performed for chronic ear surgery. Forty-eight patients underwent surgery via retroauricular incision for chronic otitis media or for chronic otitis media or cholesteatoma between March 2009 and January 2010. The skin around the auricle was divided into six areas. The sensation of each area was assessed before the surgery and 3 days, 7 days, 1 month, 3 months, and 6 months after the surgery, using the Semmes-Weinstein monofilaments. The patients were also asked to record the sensation that they felt using the visual analog scale (VAS). In the objective sensory assessment, only area 5, which corresponds to the retroauricular area, showed significant sensory loss. Three months after the surgery, the sensation was recovered to a level comparable to that before the surgery in most of the patients. The mean subjective VAS score was 10 prior to the surgery, 8.56 (± 1.08) 3 months after the surgery, and 9.32 (± 0.74) 6 months after the surgery, respectively. In conclusion, following chronic ear surgery, the sensation of the auricle was recovered to the previous level within 3 months. Therefore, patients who are to undergo retroauricular incision should be informed that they will experience temporary sensory loss for approximately 3 months after the surgery.