Status Of Ossicular Chain Research Articles

Study of malleus as a prognostic indicator on hearing outcomes after tympanomastoid surgery: A prospective observational study

Tympanomastoid surgery comprises a range of surgeries (cortical, radical, modified radical). Pre-operative auditory deficit in a patient with cholesteatoma may be correlated with ossicular chain status. The incus is often expected to be eroded, which may not be true for the malleus. The presence of malleus and it’s significance on the post-operative needs to be studied further. The purpose of our study is to determine the effect of intraoperative status of malleus on the post-operative hearing outcomes of patients undergoing canal wall-down mastoidectomy. A prospective observational study of 24 patients was conducted, where pre-operatively pure tone audiometry (PTA) was performed. Intraoperatively, the status of malleus was noted. Canal wall down mastoidectomy was done. Post-operative PTA was recorded after 3 months and both audiograms compared. An air bone gap (ABG) of less than 20dB post-operatively was considered significant functional improvement. In patients with a preserved malleus, mean improvement was 25.2dB (±9.8), whereas patients in whom malleus was remove had mean 16.8dB (±10.49) improvement. Similar results were found by Lu et al, Blom et al and Haberman et al. Haberman et al theorised the concentration of sound waves and preservation of middle ear volume as a contributing factor to the results. Hence it was concluded that relatively better post-operative audiological outcomes were obtained when malleus was present/preserved intraoperatively.

Does the ChOLE classification relate to the duration of surgery?

Cholesteatoma, a challenging entity in otologic surgery, necessitates a standardized classification system for effective communication among healthcare providers and consistent reporting of surgical outcomes. The ChOLE Classification System, introduced by Linder et al., stages cholesteatoma based on extension (Ch), ossicular chain status (O), life-threatening complications (L), and Eustachian tube function and mastoid pneumatization (E). We classified 199 patients who underwent cholesteatoma surgery between 2019 and 2023 in our University Hospital to assess the distribution of the ChOLE stages and to examine the relationship between the ChOLE stages and the duration of surgery. This study revealed significant correlations between the ChOLE stage and respective subgroups of the classification and duration of surgery and thus complexity of procedure. Despite limitations, the ChOLE classification proves valuable in predicting surgical complexity and optimizing patient care. Further research is warranted to validate these findings and enhance cholesteatoma management strategies.

A tailored approach in cholesteatoma surgery.

In recent years, new techniques have been added to cholesteatoma surgery, and established microsurgical approaches are being reconsidered. This study aims to present the importance of individualized decision-making for the selection of an intact canal wall (CWU) or canal wall down (CWD) surgical procedure for each patient. Using the "ChOLE" classification we categorized 264 operations retrospectively. 162 CWU and 102 CWD surgeries were performed. We focus to determine why a CWD procedure was chosen quite frequently despite some low-stage cases. Furthermore, we evaluated recidivism and hearing outcomes. Smaller cholesteatomas (Ch-stage 1a, 1b & 2a) were found in 182 patients (70%), ossicular chain status feasible for straightforward reconstruction (O-stage 0, 1 & 2) was present in 186 patients (70%), minor complications due to the cholesteatoma (L-stage 1) were infrequent with 28 cases (11%) and a well-pneumatized mastoid was found in 144 cases (55%). Recidivism rates were low (7%) without any difference in both groups and a mean follow-up time of 4 years and 8 months. In primary surgeries there was a significant difference (p < 0.05) in postoperative mean air-bone gap (ABG) between CWU (17dB) and CWD (27dB). The main goals of cholesteatoma surgery remain the avoidance of recidivism and optimal hearing rehabilitation. We recommend a tailored approach in the treatment of cholesteatomas and not a dogmatic one. Surgeons should not hesitate to perform a CWD procedure if required. Performed correctly it results in a dry ear and CWD surgery should remain in the skill set of the otologic surgeon.

Correlation between Clinical and Audiological Factors with Ossicular Chain Continuity in Chronic Otitis Media

Introduction: Chronic otitis media (COM) with the perforation of the tympanic membrane, myringoplasty is preferred treatment, but if ossicles are involved, myringoplasty is done with ossiculoplasty which is termed as tympanoplasty. Preoperative assessment of ossicular status is important to decide the type of tympanoplasty. Ossicular chain continuity is generally seen in the patient who has short duration of disease and smaller air–bone gap. Our study was conducted to support the relationship between preoperative clinical, audiological, and other factors in relation to the ossicular chain status. Materials and Methods: This was a prospective, cross-sectional study conducted at a tertiary care center, for 2-year duration (November 2019 to November 2021), on 100 patients who presented with COM (mucosal type). Preoperative diagnosis and assessment based on the clinical examination and investigations were compared with operative findings. Results: Thirty percent of the patients had ear discharge duration &lt;1 year, 28% had 1–5 years, and 18% patients had 6–10-year duration. Hearing loss was present in 80% of the cases. Correlation of pure-tone average (PTA) with ossicular chain status was significant with P = 0.028. The majority of patients were in the moderate category 31% and 19.36% of patients had ossicular chain defect. The second common category was mild hearing loss (24%), of which 4.17% of patients showed ossicular chain defect. Conclusion: Maximum percentages of patients with severe hearing loss had ossicular chain discontinuity followed by profound hearing loss. Most of cases had moderate to moderately severe conductive hearing loss in PTA. As the air–bone gap increases, the possibility of ossicular discontinuity increases.

Correlation Between Pure Tone Audiometry Values and Middle Ear Ossicular Chain Status in Chronic Otitis Media: Study in a Tertiary Health Care Centre.

In this study, we attempt to compare the pure tone audiometry findings with ossicular chain status intraoperatively in patients of chronic otitis media. 102 patients who presented with COM during a period of one year and met the inclusion criteria were included in the study. All patients underwent preoperative pure tone Audiometry and findings were tabulated. All patients were evaluated intraoperatively by the same surgeon and observations were made regarding ossicular chain integrity. Small central perforation was noted in 10%, medium central perforation in 38.57%, large central perforation in 27.14% and subtotal perforation in 24.28%. 71.56% patients had an intact ossicular chain, of which 94.5% was mucosal disease and 5.5% were squamous disease. 29 cases showed eroded/absent ossicles, out of which, 28 had squamous type and 1 case had central perforation. Ossicular status was classified based on Austin Classification. Conductive hearing loss was found to be maximum where all 3 ossicles were eroded/absent, with a mean AB gap of 45.33 and mean air conduction threshold of 60.33. There is a good correlation between the hearing threshold of the patient and the status of ossicular chain. Preoperative knowledge of the degree of hearing loss and status of ossicular chain would allow the surgeon to plan proper ossicular reconstruction and give the patient a better advice regarding prognosis of hearing improvement after surgery.

Myringoplasty - A Rewiev of 438 Cases.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Comparison of Ossicular Chain Status by Pre-Operative Cone Beam Computed Tomography (CBCT) with Intra-Operative Findings in Patients with Conductive Hearing Loss

Comparison of Ossicular Chain Status by Pre-Operative Cone Beam Computed Tomography (CBCT) with Intra-Operative Findings in Patients with Conductive Hearing Loss

Intra-Operative Ossicular Chain Status in Patients with Chronic Otitis Media.

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)-mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle.

Study of ossicular chain status in chronic otitis media patients at a tertiary care hospital in southern Bihar

Background: The objective is to assess the ossicular status and statistically evaluate the extent of ossicular destruction intraoperatively in chronic otitis media (COM) patients. Knowledge of pattern of involvement of ossicular chain in COM cases may help us to determine the type of reconstruction needed during surgery. The findings of this study could be exploited to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. Methods: Prospective observational study conducted over 2 years in diagnosed patients posted for surgical management and fulfilling the inclusion criteria. Intraoperative status of ossicles was noted for various types of COM and outcome was evaluated. Results: Out of 92 patients, 59 (64.1%) had mucosal and 33 (35.9%) had squamosal disease. Ossicular chain was eroded in 41 cases (44.6%). 9 out of 59 (15.3%) mucosal cases and 32 out of 33 squamosal cases (97%) reported ossicular erosion. Most frequently involved was long process of incus (44.6%) &gt;stapes (9.8%) &gt;malleus (8.7%). Order of involvement (Austin-Kartush classification) was found as: type A (26.1%)&gt;B (9.8%)&gt;C (8.7%). 67.4% belonged in the group 15-30 years. Male: female ratio=1:1.5. Conclusions: Degree of ossicular destruction is much greater in squamosal COM, owing to overproduction of cytokines and inflammatory mediators and due to presence of cholesteatoma and/or granulations. The long process of incus was found to be most vulnerable. Malleus was found to be the most resilient among all ossicles.

Is pre-operative audiometry a reliable predictor of ossicular chain condition?

ObjectiveInvestigation of ossicular chain (OC) status before surgery is important for preoperative patient consultation. This research aimed to investigate the relationship between pre-operative audiometric values and intra-operative OC condition in a relatively large population of chronic otitis media (COM) surgeries. MethodsIn this descriptive-analytic cross-sectional study, we evaluated 694 patients who underwent COM surgeries. We analyzed pre-operative audiometric data and intraoperative findings including ossicular anatomy, ossicular mobility, and the condition of middle ear mucosa. ResultsThe optimal cut-off values of pre-operative speech reception threshold (SRT), mean air-conduction (AC), and mean air-bone gap (ABG) for predicting OC discontinuity were 37.5 dB, 37.2 dB, and 28.4 dB, respectively. For the prediction of OC fixation, the optimal cut-off points of SRT, mean AC, and mean ABG were 37.5 dB, 40.3 dB, and 32.8 dB, respectively.The computing of Cohen's d (95 % confidence interval) demonstrated the greater mean ABG in ears with OC discontinuity in comparison with ears with normal ossicles in all types of pathologies. There was a descending trend of Cohen's d from cholesteatoma to tympanosclerosis and then to granulation tissue and hypertrophic mucosa.There was a substantial relation between the type of pathology and OC status (P < 0.001). Ears with tympanosclerosis plaque had the most fixed OC among all types of pathologies (40 ears, 30.8 %), and ears with no pathology had the most normal OC (135 ears, 83.3 %). ConclusionsThe results supported the view that pre-operative hearing is a key determining factor for the prediction of OC status.

TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Background: Tympanoplasty is done in cases of chronic otitis media. Middle Ear Risk Index (MERI) Scale is used to predict the outcome of tympanoplasty, based on various risk factors like otorrhoea, perforation, ossicular chain status, cholesteatoma, smoking and middle ear granuation/effusion. The objective of the study was to report the success rate of graft uptake, postoperative gain in hearing threshold and to find out the association of success to the different categories of MERI scale. Methods: A prospective study of 75 cases of chronic otitis media who underwent tympanoplasty, was done over one year. Convenience sampling method was done. Clinical and audiological evaluation was done pre- and post- operatively. Risk categorization based on MERI scale was done. Data were recorded and analyzed using SPSS 16. Results: Out of 75 cases, 39 (52%) cases were male and 36 (48%) were female. The mean age was 24.55 years±11.545. Overall, 53 (70.66%) cases had successful graft uptake. MERI 1-3 group had 82.6 % (38/46), MERI 4-7 group had 64.7 % (11/17) and MERI 8-12 group had only 33.33% (4/12) graft uptake, (p-value 0.003). Above-10-year age group had higher graft uptake rate and hearing gain. Graft acceptance was seen equal in dry or wet ear, and in unilateral or bilateral perforation. Conclusions: Tympanoplasty done in cases with lower MERI scale and more than 10 years age group was associated with higher graft acceptance. More than 10 years age group had better hearing gain. The status of middle ear, dry or wet and laterality of perforation had no association for graft acceptance.

Endoscopic vs microscopic facial nerve decompression for traumatic facial nerve palsy: a randomized controlled trial.

To explore a minimally invasive trans-canal endoscopic facial nerve decompression for traumatic facial nerve palsy and compare it with microscopic facial nerve decompression. 35 and 38 patients underwent endoscopic and microscopic facial nerve decompression, respectively, for traumatic facial nerve palsy. Onset of symptoms, type of temporal bone fracture, day of surgical intervention following trauma, ossicular chain status and nature of insult to facial nerve were observed. Time period for recovery (House Brackmann grade ≤ 3), long term recovery rates, pre- and post-operative hearing status, surgical time and post-operative pain were compared between groups. Maximum patients in endoscopic and microscopic groups (77.1% and 76.3%, respectively) had acute onset of symptoms. 57.1% (20/35) had longitudinal, 17.1% (6/35) had transverse and 25.7% (9/35) had mixed fractures in endoscopic group. In the microscopic group, 57.9% (22/38) had longitudinal, 18.4% (7/38) had transverse and 23.7% (9/38) had mixed fractures. The mean (± S.D.) post-operative air-bone gap in endoscopic and microscopic group were 16.47 ± 4.5dB and 19.4 ± 5.2dB, respectively, which was statistically significant. The mean (± S.D.) time period for recovery of endoscopic and microscopic groups were 14.4 ± 5days and 22.5 ± 7days, respectively (p value < 0.05). The difference in post-operative pain between the two groups was also statistically significant. The difference in long term recovery rates was not statistically significant (p > 0.05). Endoscopic facial nerve decompression results in early recovery, less post-operative pain and better post-operative air-bone gap closure when compared to conventional microscopic technique.

Prognostic role of EAONO/JOS, STAMCO, and ChOLE Staging for Exclusive Endoscopic and Endoscopic-Microscopic Tympanoplasty.

The aim of the study is to evaluate cholesteatoma's surgical outcomes in patients treated with endoscopic ear surgery (EES) or a combined endoscopic-microscopic approach (cEMA) according to STAM, STAMCO, ChOLE, and EAONO/JOS system (EJS) classifications and staging. Retrospective study. Monocentric study in a tertiary referral center. One-hundred sixty-eight patients who underwent EES or cEMA for cholesteatoma between 2010 and 2018 were classified according to the abovementioned classification and staging. Data on cholesteatoma's recurrence and residual rates were collected. Inferential statistical analysis was performed to evaluate surgical outcomes and the prognostic value of classifications and staging. The recurrence rate was significantly lower in cholesteatomas classified in EJS stage 1 (2.6%) and STAM stage 1 (0%). A comparison of the different stages of the disease showed a significantly lower recurrence only for stage 1 versus the superior stages of both classifications. Involvement of mastoid bone was associated with a higher risk of recurrence (odds ratio [OR]: 4.12; p = .031). Attical involvement was associated with a higher risk of residual cholesteatoma (OR: 1.165; p = .046). EES or cEMA represents an effective treatment for middle ear cholesteatoma. The STAM classification and the EJS have shown a prognostic value, with STAM 1 and EAONO-JOS 1 stages associated with a better prognosis. Mastoid involvement represents a risk factor for recurrence. Attic localization is associated with residual disease. Localization at difficult access sites did not implicate a higher risk for recurrence or residual. ChOLE classification, Ossicular chain status, and complication status did not provide prognostic information regarding recurrence or residual cholesteatoma.

Intraoperative findings during Open mastoido-epitympanectomy at a tertiary center

Introduction: Chronic otitis media is a common entity in our country. Surgical eradication of disease is the treatment of choice for squamous chronic otitis media. The objective of this study was to assess the pathology, its extent and associated complications in patients who underwent open mastoido-epitympanectomy for chronic otitis media squamous at a tertiary care center (Dhulikhel Hospital) in Nepal. Materials and methods: Medical records of 111 patients who underwent OMET at our center from June 2017 to June 2021 were analyzed retrospectively. Demographic parameters, clinical presentation, audiometric data, intraoperative pathology and their distribution, involvement of bony landmarks and ossicular chain status were recorded and analyzed. Results: There were 64 male and 47 female patients included in our study. Their age ranged from 6 to 69 years. The commonest finding during examination under microscopy was posterosuperior retraction pocket (42.3%). Cholesteatoma was the commonest intraoperative pathology (86.5%), majority with cholesteatoma widespread involving both tympanic and mastoid cavities. Ossicular chain erosion was reported in 96.4% patients. Conclusion: Squamosal otitis media is common in our setup, with extensive distribution of pathology in middle ear cleft, and possible bony landmarks erosion.

Prognostic factors of hearing outcome in patients with chronic suppurative otitis media following tympanoplasty: a retrospective cohort study.

Research on the factors affecting the functional outcome of tympanoplasty in chronic suppurative otitis media (CSOM) is limited. This study aimed to investigate the prognostic factors of hearing outcome in CSOM patients following tympanoplasty. The multivariate logistic regression analysis is used to evaluate the influence of demographic, audiological, clinical and disease factors on the postoperative prognosis of CSOM. A total of 179 CSOM patients who received surgery between January 2016 and December 2019 were retrospectively included. The inclusion criteria are mainly based on clinical classification of otitis media and surgical classification guidelines [2012]. These patients were divided into an effective group (n=132) and a non-effective group (n=47) according to their postoperative air-bone gap (ABG) value. Multivariate analysis was performed according to the pure tone hearing results 1 week before operation and 4 weeks after operation. The type of preoperative hearing impairment, middle ear cholesteatoma, ossicular chain status, tympanic perforation site, repair material, tympanum sclerosis, and surgical methods were significantly different between the effective and non-effective groups (all P<0.01). The speech reception threshold (SRT) (36.88±15.54 vs. 27.68±13.75, P<0.001) and ABG (18.53±9.30 vs. 10.89±5.07, P<0.001) values were markedly reduced after surgery in the effective group but not in the non-effective group. Furthermore, the postoperative decreases in the SRT (9.20±9.69 vs. 2.021±7.34, P<0.001) and ABG (7.64±8.57 vs. 0.45±7.322, P<0.001) values were considerably higher in the effective group than the non-effective group. After multivariate logistic regression analysis, we found that the type of preoperative hearing impairment [P=0.031; odds ratio (OR) =2.378], ossicular chain status (P=0.002; OR =4.430). Our research shows that the curative effect of conductive deafness before operation is 2.378 times better than that of mixed deafness, the curative effect of complete and unfixed ossicular chain before operation is 1.080 times better than that of interrupted ossicular chain, and the curative effect of complete ossicular chain but fixed ossicular chain is 4.430 times better than that of interrupted ossicular chain. Our findings may help to predict the postoperative prognosis of patients, thus facilitating the development of corresponding treatment strategies.

Comparison of the EAONO/JOS, STAMCO and ChOLE cholesteatoma staging systems in the prognostic evaluation of acquired middle ear cholesteatoma in children.

To compare the performance of the EAONO/JOS, STAMCO, and ChOLE Cholesteatoma Staging Systems in prognostic evaluation of children acquired middle ear cholesteatoma after primary surgery and identify the other factors that could predict cholesteatoma recidivism. And the correlation between the staging and the recidivism of cholesteatoma after grouping according to operation was evaluated. A total of 123 ears of 118 patients that underwent surgery for primary cholesteatoma from November 2008 to May 2020 were included in this retrospective study, and then classified and staged according to the EAONO/JOS, STAMCO, and ChOLE cholesteatoma staging system, respectively. Each indicator involved in the system above was analyzed separately to evaluate its prognostic value for cholesteatoma recidivism. The type of surgical procedure performed (P = 0.020) was shown to be associated with cholesteatoma recidivism. Cholesteatoma location the supratubal recess (S1) (P = 0.026, HR = 3.614, 95% CI 1.137, 7.945), and the sinus tympani (S2) (P = 0.004, HR = 4.208, 95% CI 1.574, 11.250) were shown to be significantly associated with disease recidivism. When focusing on the CWU operation group, ossicular chain status in STAMCO stage (P = 0.043) and in the ChOLE stage (P = 0.018) were significantly associated with cholesteatoma recidivism. The results had shown no association between the three stages and cholesteatoma recidivism in the CWD and endoscopic surgery groups. Based on our study, the EAONO/JOS, STAMCO, and ChOLE Classifications have limited value in predicting cholesteatoma recidivism, in acquired middle ear cholesteatoma in children. Adding the pathological status of the ossicular chain may be useful for predicting the recidivism of cholesteatoma. Additional validation studies are entailed to definitively assess the clinical utility of these classifications.

Ossicular Chain Status in Adults with Chronic Otitis Media Mucosal at a Tertiary Referral Hospital in Nepal

Introduction&#x0D; Chronic Otitis Media (COM) is a common condition characterized by perforation of the tympanic membrane and inflammation of middle ear cleft mucosal lining for at least 2-6 weeks. This study was carried out to find out the status of the middle ear ossicles in patients with COM mucosal and to correlate with clinical parameters.&#x0D; Materials and Methods&#x0D; This retrospective clinical study comprises 106 myringoplasty patients at the department of ENT, Shree Birendra Hospital. Their preoperative PTA, four frequencies (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) Air Conduction Thresholds (ACT), and Air Bone Gap (ABG) were recorded. Ossicular chain integrity and mobility evaluated intraoperatively were noted. Ossicular chain status was analyzed with ACT and ABG.&#x0D; Results&#x0D; The ossicles were intact and mobile in 91.5%, either fixed/ restricted or disrupted in 8.5%. Mean ACT and ABG comparisons in intact and ossicular chain defect groups were statistically significant. Frequency-specific ACT at all four frequencies and ABG except at 4000 Hz in the two groups were also statistically significant to predict the ossicular involvement. The group with ossicular defect had moderate to severe Conductive Hearing Loss (CHL).&#x0D; Conclusion&#x0D; Mean as well as frequency-specific ACT and ABG can be considered as a potential preoperative predictor for ossicular chain status in COM mucosal.

Non-Echoplanar Diffusion Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma

Introduction: Cholesteatomas are lesions that develop in pneumatized areas of the temporal bone, such as the middle ear and mastoid, or both, and are extremely rarely detected in the external auditory canal. Because it has benefits over CT, diffusion weighted imaging MRI (DWI-MRI) can be a useful technique in the identification of cholesteatoma. Image distortion and artefacts are less visible with non-echo planar imaging DWI techniques than with other DWI techniques. Aims and Objectives: 1) To assess the usefulness of HRCT scan in Chronic suppurative otitis media (CSOM) with cholesteatoma in depicting the status of the middle ear structures. 2) To correlate HRCT findings of temporal bone with surgical findings in Chronic suppurative otitis media (CSOM) with cholesteatoma with respect to the following parameters: Presence or absence of cholesteatoma, Extent of cholesteatoma, Status of ossicular chain, Integrity of the facial canal, Detection of erosions or dehisence in the bony labyrinth, and Detection of erosions or dehisence in the dural or sinus plates. 3) Comparison with Non Echo planar imaging diffusion weighted for presence or absence of cholesteatoma. 4) 3D FIESTA Magnetic resonance imaging with 3D reconstruction of membranous vestibule and cochlea for better delineating associated complications. Materials and Methods: Total 40 patients of clinically suspected CSOM with cholestaetoma were enrolled for this study. All patients were scanned using a non-contrast High-resolution computed tomography technique and MRI. HRCT findings were noted according to the proforma. MRI DWI was recorded as either positive or negative for cholesteatoma &amp; directly correlated with post-surgical presence or absence of cholesteatoma.3D FIESTA for detection of membranous labyrinthine erosion/defect was correlated with surgical findings of bony labyrinthine erosions. Results: Cholesteatoma was shown to be common in the third decade of life in our study. The most often implicated middle ear structures in our investigation were the epitympanum, aditus, and antrum. The most often eroded ossicle is the stapes, followed by the incus. The tympanic section of the facial canal is the most often affected segment, while the posterior semicircular canal is the most commonly degraded of the bony labyrinth structures. Conclusion: HRCT temporal bone, in combination with non-echoplanar DWI MRI and 3D Fiesta, can help with accurate diagnosis and pre-operative assessment of cholesteatoma.

Analysis of long-term anatomic results of radical mastoidectomy.

A long-term, retrospective, non-controlled study was performed on the drainage results of mastoidectomy (both radical and modified radical) and the relevant statistical factors that could influence the anatomic outcome were defined. The present study took into consideration the same cohort of 200 patients we have communicated with before in our previous studies concerning the long-term functional results of mastoidectomy and long-term results of ossicular replacement with biovitroceramic prosthesis. The patients were clinically followed for the same period of 8.12 years. The drainage (anatomic) results, similar to previously published functional results, were defined by analytical function of the severity and the period of evolution of disease. The main goal was to define the situations and factors (presence of complications, type of disease, type of tympanic perforation or status of ossicular chain) that influenced the drainage results that could provide us with some type of anatomical prognosis. The follow-up started at the moment of complete epithelization for each cavity as time represents the main study comparison criteria. Drainage failure was assessed by the number of otorrhea episodes. It was concluded that practically and ideally, a maximum of 84% of the mastoid and petrous cells can be cleaned out. The results of 78% drainage success are congruent to this theory. The remaining 16% of cells may contain irreversible lesions.

Correlation between peri-operative complication in middle ear cholesteatoma surgery using STAMCO, ChOLE, and SAMEO-ATO classifications

PurposeTo compare the relationship between the variable “complication” and the other variables of middle ear cholesteatoma classifications (STAMCO, ChOLE, and SAMEO-ATO).MethodsRetrospective study of 110 patients that underwent 132 middle ear surgeries between the 1 January 2012 and the 31 December 2019 for chronic otitis with cholesteatoma classified according to STAMCO, ChOLE, and SAMEO-ATO classifications in a tertiary health care centre.ResultsOlder age, male gender, STAMCO-T, and SAMEO-ATO [O1, T, O2, (s -)] and mastoid involvement (STAMCO-M and ChOLE-Ch) were associated with an increased risk of complication report.ConclusionsIn our series, statistical analysis pointed out a relationship between surgical complications and age, gender, site, mastoidectomy type, and ossicular chain status at surgery. The choice of variables to be recorded for cholesteatoma staging should be carefully balanced, considering that “complication” variable could be a repetitive item.