Posterior Meatal Wall Research Articles

To evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after canal wall down (CWD) mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

To evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after canal wall down (CWD) mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

Middle ear adenoma with facial palsy: A case report and a review of the literature

A 52-year-old man presented to our emergency department with an acute onset of right-sided facial nerve (FN) palsy of House-Brackmann grade V. Electroneurography (ENoG) was conducted with no response at the right FN, as compared with the left FN (0%). We performed a biopsy of the right middle ear mass and histological studies showed the tumor to be neuroendocrine tumors (NET) of the middle ear. We resected the tumor with canal wall down mastoidectomy and reconstructed the posterior meatal wall with soft tissue. Three months after surgery, the FN paralysis had improved with House-Brackmann grade II. We reviewed cases of NET with FN palsy, and nine patients, including our case, have been reported. Our case is the first report of ENoG for the description of FN palsy due to NET. Although the ENoG value was 0%, it was remarkably improved by surgery. The other cases of NET patients with FN palsy also recovered FN function after surgery. These results suggest that it is recommended to perform the total resection of the tumor to improve the FN function.

Intraoperative Classification of Cholesteatoma Using ChOLE Classification and Evaluating its Treatment Outcomes Using Inside Out Approach Mastoidectomy.

The primary objective is to classify acquired cholesteatoma according to the ChOLE classification system based on the preoperative and intraoperative findings, and to describe prevalence of each stage. The secondary objective is to correlate the extent of inside out approach mastoidectomy required with the staged extent of cholesteatoma. A non-randomized Prospective Observational study conducted in 67 patients in a tertiary care hospital. Each case was categorized according to the ChOLE classification system including cholesteatoma extension, ossicular chain status, life threatening complications and eustachian tube dysfunction. Based on the extent of disease, inside out approach mastoidectomy was done and results analysed. Most patients presented with stage 2 disease [67%]. Canal wall was preserved for all stage I, and in stage II cholesteatoma canal wall was either kept intact, reconstructed or lowered based on the extent of erosion of posterior meatal wall and cholesteatoma extension. All stage III underwent canal wall down mastoidectomy. Staging of cholesteatoma by ChOLE classification allows standardization in reporting gravity of disease and surgical outcomes. Inside out approach mastoidectomy contributes to the successful surgical management of cholesteatoma by eradicating the disease with the creation of a smaller cavity.

Canal wall-down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma: focus on postoperative middle ear status

Objectives: We reviewed surgical results of canal wall-down tympanoplasty (CWDT) with soft posterior meatal wall reconstruction (SWR) for acquired cholesteatoma (AC), and identified factors associated with surgical outcomes.Methods: Results from 119 ears with AC (pars flaccida, n = 99; pars tensa, n = 20) that underwent CWDT with SWR were retrospectively reviewed. We defined postoperative balloon-like retraction (PBR) with web formation, which needed reoperation to clean accumulated cerumen, as postoperative deep retraction pocket (PDRP).Results: Residual cholesteatoma was found in 11 ears (9.2%). Seven residual cholesteatomas were treated with outpatient operation. Seven ears (5.9%) showed PDRP. A transcanal approach was applied to all PDRPs. Postoperative mastoid reaeration was observed in 57 ears (47.9%). No factors significantly associated with residual cholesteatoma or PDRP were identified. The frequency of postoperative mastoid reaeration was significantly higher among cases with young age (<50 years), stage I cholesteatoma, or type I ossiculoplasty.Conclusion: CWDT with SWR showed low rates of residual cholesteatoma or postoperative deep retraction pocket (PDRP). Most residual cholesteatomas and PDRPs could be dealt with using a minimally invasive procedure. Young age, stage I cholesteatoma, and type I ossiculoplasty were associated with postoperative mastoid reaeration. This procedure seems fully feasible for surgical treatment of AC.

Bioglass reconstruction of posterior meatal wall after canal wall down mastoidectomy

BackgroundCanal wall down (CWD) mastoidectomy has many drawbacks including chronic otorrhea, granulations, dizziness on exposure to cold or hot water and tendency of debris accumulation in the mastoid cavity demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). ObjectivesTo assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using bioactive glass (BAG) that is fabricated and built up intraoperatively. Patients and methodsThis study was applied on 20 patients had atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by BAG that was prepared and built up intraoperatively. All patients were exposed to full preoperative evaluation and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. ResultsDuring a follow up of 12 to 36 months, postoperative appearance of external auditory canal contour was found smooth without hidden pouches, irregularities nor stenosis in all cases. No registered granulation, foreign body reaction, nor extrusion and/or displacement of the BAG material. No reported facial palsy or recurrent cholesteatoma. Significant hearing improvement was statistically reported (p = 0.0006). ConclusionSurgical reconstruction of the PMW using BAG that operatively fashioned immediately after CWD mastoidectomy appears to be reliable without considerable complications giving smooth appearance of the PMW and improving the hearing.

Cartilage versus partial ossicular replacement prosthesis in ossiculoplasty during cholesteatoma surgery

ObjectiveThis study aims at comparing cartilage ossiculoplasty by lever method with ossiculoplasty by partial ossicular replacement prosthesis during cholesteatoma surgery.Patients and MethodsThis is a prospective study that was conducted on 36 cases having cholesteatoma; they were randomly divided into two groups of 18 in each group. In the first group (cartilage group), ossiculoplasty was performed with cartilage. In the second group (prosthetic group), ossiculoplasty was performed by partial ossicular replacement prosthesis. In both groups, eradication of the cholesteatoma was performed first at the same sitting of the ossiculoplasty by canal wall down tympanomastoidectomy with reconstruction of the posterior meatal wall at the same sitting.ResultsWithin the follow-up period (1 year at least), the total rate of reported complications was relatively, but not significant, higher in the prosthesis group (50%) in comparison with the cartilage group (27.7%). There was a significant postoperative improvement in the air-bone gap in both groups; however, there was no significant difference between the two groups regarding improvement of the air-bone gap either 6 or 12 months after surgery.ConclusionCartilage ossiculoplasty by lever method is an easy procedure for using an autogenous material in ossiculoplasty with no reaction, no extrusion, and also with acceptable hearing outcome.

Estudo da Abertura Externa do Aqueduto Vestibular como Referência na Preservação do labirinto pelo acesso suboccipital retrossigmóide transmeatal

A abertura externa do aqueduto vestibular foi avaliada como uma referência para ajudar na preservação do labirinto por meio do acesso suboccipital retrossigmóideo transmeatal. Foram estudados ossos temporais, segmentos cefálicos, pacientes portadores de neurinomas do acústico e exames por tomografia computadorizada dos ossos temporais. As correlações existentes entre a abertura externa do aqueduto vestibular, poro acústico interno e crista transversa foram observadas, e realizadas medidas entre essas estruturas. Dissecações foram efetuadas nas partes anatômicas para a exposição da abertura externa do aqueduto vestibular junto à saída do saco endolinfático. A parede posterior do meato acústico interno foi aberta, sem atingir, porém, a abertura externa do aqueduto vestibular, que foi usada como referência para o limite lateral da brocagem. Finalmente, o aqueduto vestibular, a cruz commune e o canal semicircular posterior foram abertos para certificar-se de que eles não haviam sido lesados anteriormente, e para comprovar que ainda existia um limite ósseo entre a extremidade lateral do meato acústico interno e o labirinto. A mesma referência foi utilizada em 24 pacientes portadores de neurinomas do acústico, com o propósito de preservar as partes óssea e membranosa do labirinto, e foi estudada por tomografia computadorizada dos ossos temporais. Existia sempre uma correlação entre a abertura externa do aqueduto vestibular, a extremidade lateral do meato t o labirinto. A distância entre o poro acústico interno e a abertura externa do aqueduto vestibular nunca foi menor que a distância entre esse mesmo poro e a crista transversa. A abertura externa do aqueduto vestibular estava, em geral, lateral à projeção perpendicular da extremidade meatal lateral na superfície petrosa posterior, e, quando sob linha direta da visão, fornecia um ângulo apropriado para que pudessem ser evitadas lesões na porção mais póstero-medial do labirinto. Se a parede posterior do meato não fosse brocada até a abertura externa do aqueduto vestibular, o labirinto poderia ser preservado. Os resultados dos casos cirúrgicos mostraram que o labirinto pôde ser mantido intacto em todos os pacientes, e que os tumores foram completamente removidos. Por meio de exames de tomografia computadorizada dos ossos temporais pode-se avaliar o grau de afastamento do hemisfério cerebelar, necessário para a obtenção de um ângulo seguro de exposição da parede meatal posterior, e a extensão dessa parede que pode ser aberta sem causar danos ao labirinto. O estudo anátomo-topográfico, as observações tomográficas e os resultados obtidos na presente casuística comprovam que a abertura externa do aqueduto vestibular pode auxiliar na preservação do labirinto durante a brocagem da parede posterior do meato acústico interno, pelo acesso suboccipital retrossigmóideo.

Posterior canal wall reposition for management of cholesteatoma: Technique and results

ObjectiveThe main goal of surgery in acquired middle ear cholesteatomas is the complete eradication of the disease with an ear free of discharge. This can be performed either by open or closed techniques with their benefits and drawbacks. We present the technique of reposition of the posterior canal wall for the management of cholesteatoma cases and its results and outcome. Patients and methodsThis study included 31 patients with primary acquired middle ear cholesteatoma. The surgical technique included complete cortical mastoidectomy, wide posterior tympanotomy, dividing the bony posterior meatal wall with a micro-sagittal saw and its removal, dissection and eradication of cholesteatoma, and repositioning the canal wall segment in its anatomical site. ResultsNo significant intraoperative complication occurred. An injury to the dura occurred in one patient. Damage of the bony posterior canal wall occurred in two patients during saw cutting. Residual cholesteatoma was found in two patients. No dislocation or necrosis of the reconstructed posterior canal wall was noted and the new reconstructed external ear canal appeared to be of near normal size, shape, and contour. ConclusionThis technique provides optimal surgical exposure and access to areas that are difficult to reach by CWU approach, allows removal of the cholesteatoma without intraoperative complications, decreases the rate of residual cholesteatoma, restores near-normal anatomy of the external auditory canal, and avoids the sequelae of the open mastoid cavity. Therefore, it would be a feasible alternative to the standard CWU and CWD procedures.

Platelet-Rich Plasma in Reconstruction of Posterior Meatal Wall after Canal Wall Down Mastoidectomy.

Introduction Canal wall down (CWD) mastoidectomy has many drawbacks, including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, demanding periodic cleaning. Many of these problems can be solved by reconstruction of the posterior meatal wall (PMW). Objectives To assess the results of PMW reconstruction after CWD mastoidectomy for cholesteatoma using titanium mesh and platelet-rich plasma (PRP) mixed with bone pate. Methods This study was conducted with 20 patients that have atticoantral chronic suppurative otitis media. All cases were subjected to CWD mastoid surgery with complete elimination of the disease and reconstruction of the PMW by titanium mesh and the mixture of PRP with bone pate. All patients were exposed to a full preoperative evaluation and full postoperative assessment of the complications, the appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results The PMW reconstructed by titanium mesh and the mixture of PRP with bone pate showed a smooth contour. During the follow-up of 12 to 36 months, the postoperative appearance of the external auditory canal contour was found to be smooth without hidden pouches, irregularities or stenosis in all cases. No granulation, foreign body reaction, or extrusion and/or displacement of the titanium mesh were registered. No facial palsy or recurrent cholesteatoma was reported. Conclusion The surgical reconstruction of the PMW using PRP, bone pate and titanium mesh after CWD mastoidectomy appears to be reliable without considerable complications, giving a smooth appearance to the PMW.

The canal wall down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma. Focus on recurrence and postoperative middle ear status

The canal wall down procedure with soft posterior meatal wall reconstruction in acquired cholesteatoma. Focus on recurrence and postoperative middle ear status

SURGICAL RECONSTRUCTION OF THE POSTERIOR MEATAL WALL BY BIOGLASS VERSUS TITANIUM MESH

Canal wall down mastoidectomy has many drawbacks including chronic otorrhea not responding to medications, granulations, dizziness on exposure to cold or hot water, and tendency of debris accumulation in the mastoid cavity, necissating periodic cleaning. Many of these proplems can be solved by reconstruction of the posterior meatal wall. Aim of work: To solve the cavity proplems after CWD mastoidectomy via reconstruction of posterior meatal wall, and to compare between the outcomes of the Bioglass versus titanium mesh in reconstruction of posterior meatal wall. Patients and methods: This study was applied on 40 patients that have chronic sappurative otitis media. All cases were subjected to canal wall down mastoid surgery with complete elimination of the disease and reconstruction of the posterior meatal wall. Patients were divided to 2 groups: group (A) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by Bioglass and the group (B) was managed by canal wall down mastoidectomy with reconstruction of the posterior meatal wall by titanium micromesh; all patients were exposed to full preoperative evaluation, and full postoperative assessment of complications, appearance of the external auditory canal contour, and the hearing gain expressed by the change of the air bone gap postoperatively. Results: There is a significant difference between the two groups regarding postoperative complications mainly the postoperative granulations and discharge, the postoperative appearance of the external auditory canal contour, and the hearing gain in favor of group (A) but there is no significant difference between the 2 groups as regard the intraoperative difficulties, the other postoperative complications like wound infection, canal stenosis, extrusion or displacement of the materials and recurrence of cholesteatoma. Conclusion: Reconstruction of posterior canal wall can eliminate many of the cavity proplems after CWD mastoidectomy especially by using the Bioglass which shows better advantages than the titanium micromesh Keywords: canal wall reconstruction, Bioglass, titanium, mastoidectomy, mastoid cavity oblitration

Transcanal Endoscopic Antrostomy Hole : Its Utility in Restoring Ventilation Pathway to Epitympanum and Mastoid Antrum During Tympanoplasty

Aim: To evaluate the role of newly created transcanal endoscopic antrostomy hole as a passage in restoring the aeration of epitympanum and mastoid antrum.Materials &amp; Methods: Study design: Retrospective case series study. Study duration: From January 2013 to January 2014. Study place: Private tertiary care hospital. Patients: 27 ears of 23 adult patients (age ranging from 15years to 54years) underwent transcanal endoscopic tympanoplasty for their chronic middle ear diseases in presence of inflamed middle ear mucosa along with radiological shadows of stagnant fluid in their epitympanum and mastoid antrum. Structured three months follow-up was ensured in every case. Intervention: A hole was created at a selected site of posterior meatal wall purely through transcanal endoscopic approach that established direct communication between mastoid antrum and external auditory canal. Thereafter this newly created passage was used for three purposes- assessment of the condition of mastoid antrum, performing the water test for checking epitympanic patency and in few cases placement of temporary tube for postoperative ventilation and drainage of middle ear. Main out come measures: The feasibility, performance and management of transcanal endoscopic antrostomy hole as passage for reestablishing the aeration of epitympanum and mastoid antrum.Results: The chosen site for antrostomy hole was found effective and safe in providing convenient entrance into the mastoid antrum in every case in this study with out facing technical complexity and failure. Postoperative healing of skin over antrostomy hole was found complete in all ears without any inward growth of skin in to mastoid antrum. Available post operative CT scan imaging of temporal bones showed improved aeration in their epitympanum and mastoid antrum.Conclusions: The role of transcanal antrostomy hole has been proved worthy in restoring ventilation pathway to epitympanum and mastoid antrum during tympanoplasty. This antrostomy hole has the potentiality to be considered in future for placement of long term mastoid ventilation tube in order to treat persistent atelectatic middle ear.

Avoiding mastoid cavity Problems: Mastoid obliteration using Bioactive glass

Background and objective: The aim of this study was to evaluate bioactive glass as an ideal material for the purpose of mastoid cavity elimination after mastoid surgery to avoid mastoid cavity problems. Materials and methods: In 20 patients diagnosed as cholesteatoma or chronic unsafe ear, we used different surgical techniques according to pathology and situation during surgical exploration, basically adhering to standard principles of eradicating disease in chronic unsafe ear. After performing the canal wall down (CWD) or the canal wall up (CWU) technique, mastoidectomy was followed by obliteration of mastoid cavity by particulate form Bioglass®. Cases were divided according to operative procedures, type of reconstruction and material used into 3 groups A- Canal wall up mastoidectomy followed by obliteration of mastoid cavity by particulate form Bioglass®. B- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall and obliteration of mastoid cavity by particulate form Bioglass®. C- Canal wall down mastoidectomy followed by reconstruction of posterior meatal wall by conchal cartilage and obliteration of mastoid cavity by Bioglass®. Results: Bioactiveglass paste is very effective for mastoid obliteration in the three groups with good integration to the surrounding tissues either connective tissue, bone, meninges or lateral dural sinus without any adverse reaction on the dura even with contact to Bioglass®. Infection was seen in 2 cases (10%), however was readily controlled by topical application of antibiotics daily for one week. In both cases no extrusion of the material occurred. Conclusion: The successful formation of bone with elimination of mastoid cavity problems proved that using Bioglass is appropriate for performing clinical mastoid obliteration.

Management to the posterior meatal wall at the first stage operation

Management to the posterior meatal wall at the first stage operation

Results of tympanoplasty with soft posterior meatal wall reconstruction in ears with cholesteatoma

Results of tympanoplasty with soft posterior meatal wall reconstruction in ears with cholesteatoma

Principles of cholesteatoma surgery

As a potentially life-threatening disease, cholesteatoma of the petrous bone generally requires a surgical approach. Surgery aims to produce an ear that is easy to care for and is free of recurrent or residual cholesteatoma. Hearing improvement is of secondary importance. Nevertheless the sound conduction system is generally reconstructed as a single-stage procedure. There are various possible methods of dealing with a cholesteatoma: (i) preserving or reconstructing the posterior meatal wall with an aerated mastoid (closed technique) or obliteration of the mastoid completely or partially after removal of the posterior wall (closed technique); and (ii) leaving the cavity open for inspection (open technique). In our opinion any technique where the mastoid is not open for inspection should be called a closed technique. Both techniques have their specific advantages and disadvantages.

In reference to Effect of the tympanostomy tube on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing

In reference to <i>Effect of the tympanostomy tube on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing</i>

Effect of the tympanostomy tube on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing

To evaluate the effect of the tympanostomy tube (TT) on postoperative retraction of the soft posterior meatal wall caused by habitual sniffing following ear surgery, including a mastoidectomy and soft-wall reconstruction of the posterior meatal wall. Retrospective chart review. Sixty-six ears of 64 patients with acquired cholesteatoma who underwent staged ear surgery with a soft-wall reconstruction method and mastoidectomy were enrolled; 26 out of 66 ears had habitual sniffing (sniffing positive[+]), underwent TT placement (TT positive[+]) during surgery, and were followed up for at least 8 months after surgery. Sixty-six ears were divided into sniffing+/TT+, sniffing negative(-)/TT+, and sniffing-/TT- groups, and the degree of the retraction was compared among the three groups. The distribution of the grades of the postoperative retraction of the soft posterior meatal wall was almost the same among the three groups (P = .60). Ears with severe retraction were found in 19.2% (5/26), 33.3% (7/21), and 15.8% (3/19) in the sniffing+/TT+ group, sniffing-/TT+ group, and sniffing-/TT- groups, respectively. The TT was found to be effective in preventing the development of postoperative retraction of the reconstructed soft posterior meatal wall and tympanic membrane among cases with habitual sniffing. We would suggest that TT placement is recommended during surgery for cholesteatoma if a patient was found to engage in habitual sniffing.

Verlauf der Chorda tympani bei Operationen des Mittelohres: Klinische Einteilung und ihre Bedeutung für postoperative Schmeckstörungen

The anatomical course of the Chorda tympani nerve (CTN) in the middle ear is known to be very variable, which becomes most obvious during middle ear operations. As well, postoperative gustatory dysfunction belongs to the most frequent complications after otosurgical interventions. The aim of this study was to develop a clinical classification of the intraoperatively visible course of the CTN and to demonstrate a possible correlation of its anatomic course with the prevalence of actual postoperative taste disorders. Only cases of first-time ear surgery all operated by one experienced otosurgeon were assessed. Preoperatively, gustatory testing with standardised chemical solutions (sweet, sour, salty, bitter) was performed. During surgery the course of the CTN was classified at first sight by 3 topografical criteria: The angle (A), the height (H) and the depth (D) of the nerve's emergence from the lateral tympanic wall. In cases of postoperative taste dysfunction the patients were followed-up on a regular basis. 103 patients were included in the study. The angle of the nerve;s emergence from the tympanic bone was below 30 degrees in 59 (A1), between 30 degrees and 60 degrees in 41 (A2) and within 60 degrees and 90 degrees in 3 cases (A3). The height of emergence was 33 times in the superior (H1), 61 times in the middle (H2) and 9 times in the inferior third (H3) of the posterior meatal wall. The depth of emergence lay within the plain of the tympanic sulcus in 26 individuals (D1), 44 times medially to this plain without overlapping bone (D2) and 33 times medially but covered by a bony spur (D3). The CTN was preserved in 92 procedures. Postoperatively, gustatory function was diminished in 7% of the cases. This study confirms the high diversity of the surgical anatomy of the CTN. According to the proposed classification the A1-H1-D2/3-situation belongs to the CTN-constellations observed most frequently. It is this very anatomical situation, that apparently tends to be associated with postoperative taste deficits quite regularly due to inevitable intraoperative manipulations. Taking into account the results of this study an otosurgeon might be able to anticipate the potential risk for the CTN by judging the AHD-status intraoperatively and - therefore - reduce taste disorders postoperatively. Additionally, the probability of a postoperative gustatory dysfunction depends upon the kind of underlying middle ear disease as well.

Canal wall down tympanomastoidectomy: the ‘on-disease’ approach for retraction pockets and cholesteatoma

It is well known that cholesteatoma is three-dimensional; hence, we feel that its surgical management requires a three-dimensional approach in order to achieve the best curative and functional results. Retraction pockets are undeniably caused by chronic and recurrent eustachian tube obstruction. However, we found that the presence of a large mastoid antrum was an important, additional aetiological factor in the formation of a retraction pocket and its progression to cholesteatoma formation, with bone destruction and subsequent complications. Canal wall down tympanomastoidectomy--the 'on-disease' approach--is an innovative, three-dimensional technique based on universally accepted surgical principles. We modified the technique to ensure complete exposure and thereby eradication of the disease, with a resultant small cavity. Working in a three-dimensional field, we began drilling at the posterior meatal wall, lowering it while simultaneously widening the cavity as the mastoid was drilled to reach the antrum and the aditus. The bridge was lowered and the incus removed to completely expose the entire disease. The facial ridge was debulked and the temporalis fascia graft placed so as to simplify the middle-ear cleft. We present a comprehensive report of this technique, based upon 600 patients studied retrospectively over a five-year period. After one-year follow up, 546 patients had a dry, healed cavity. Canal wall down tympanomastoidectomy performed by the on-disease approach ensures complete eradication of the disease, with excellent curative as well as functional results.