MRI for residual and recurrent cholesteatoma

Diagnosis and management of recurrent or residual cholesteatoma can be problematic. Diffusion-weighted imaging magnetic resonance imaging (MRI) sequences have been used for follow-up of such lesions

Objective of review: Evaluate whether diffusion-weighted magnetic resonance imaging is useful in the diagnosis of recurrent or residual cholesteatoma.

 

Results: A total of 575 studies were identified of which 27 met the inclusion criteria. These covered 727 patient episodes. For EPI studies: sensitivity (sd) 71.82 (24.5), specificity (sd) 89.36 (13.4), PPV (sd) 93.36 (8.1) and NPV (sd) 73.36 (15.8). For non-EPI studies: sensitivity 89.79 (12.1), specificity (sd) 94.57 (5.8), PPV (sd) 96.50 (4.2) and NPV 80.46 (20.2). Improved sensitivity of non-EPI sequences reached significance (P = 0.02).

Conclusions: Diffusion-weighted MRI is both sensitive and specific for the detection of recurrent or residual cholesteatoma following ear surgery. Non-EPI techniques are superior to EPI techniques.

Full reference: Muzaffar, J. et al. (2017) Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clinical Otolaryngology. 42(3) pp. 536–543

Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma

Outcomes for endoscopic ear surgery (EES) for pediatric cholesteatoma at a tertiary pediatric hospital.

Methods: Retrospective case series of 65 pediatric cholesteatoma cases in 38 ears. Subgrouping based on cholesteatoma type and EES type. Surgical findings, outcomes, and demographic data were evaluated.

Results: Endoscopes were used in 65 pediatric cholesteatoma cases in 38 primary ears (34 patients), followed for an average of 2.6 years (9 months to 4.6 years). The endoscope was used as the primary visualization tool in 31 (81.6%) ears (EES 2 or 3), and as an adjunct to the microscope in seven ears (EES 1). Twenty-two (57.9%) ears and 35 (53.4%) cases were transcanal endoscopic ear surgery (EES 3 or TEES). Overall, there was recurrence in five (13.2%) ears and residual in four (10.5%) ears. Cholesteatoma was acquired in 27 ears, with average age 10.9 years; and congenital in 11 ears, with average age 3.8 years. Surgical time was longer for acquired cases (226 vs. 154 minutes). Hearing outcomes were comparable for both cholesteatoma types. Residual disease was seen in three (11.1%) acquired ears and one (9.1%) congenital ear. Overall, the lowest rates of recurrent and residual disease were seen in EES 3 cases, and relatively low rates in EES 2 and 3 ears, including four (12.9%) recurrences and two (6.5%) ears with residual disease.

Conclusion: The endoscopes are a viable tool for resection of pediatric cholesteatoma and provide excellent visualization of the middle ear and associated recesses.

Full reference: Ghadersohi, S. et al. (2017) Endoscopic transcanal approach to the middle ear for management of pediatric cholesteatoma. The Laryngoscope. Published online: 23 May 2017

Incidence, 10-year recidivism rate and prognostic factors for cholesteatoma

Britze, A. et al. (2017) The Journal of Laryngology & Otology. 131(4) pp. 319-328

Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate.

The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.

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Surgical Treatment of External Auditory Canal Cholesteatoma – Ten Years of Clinical Experience

Ho, K-Y. et al. The Journal of International Advanced Otology. Published online: 9 March 2017.

Objective: To describe the clinical manifestations of external auditory canal (EAC) cholesteatoma and evaluate the surgical outcomes of reconstruction using an inferior pedicled soft-tissue periosteum flap.

Conclusions: Bony canaloplasty and obliteration with an inferior pedicled soft-tissue periosteum flap is a reliable procedure for EAC cholesteatoma.

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Endoscopy-Assisted Ear Surgery for Treatment of Chronic Otitis Media

Ulku, H. The Journal of craniofacial surgery. Published online: March 2017

11574-2The objective of this study was to analyze the results of endoscopy-assisted ear surgery for the treatment of chronic otitis media with cholesteatoma, adhesion, or retraction pockets.

Oto-endoscopic eradication of the cholesteatoma or epithelial tissue from hidden area after the all visible cholesteatoma removal by oto-microscope improves the quality of surgery, significantly decreases the frequency of the canal wall-down procedure and posterior tympanotomy requirements with acceptable residual cholesteatoma rates.

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Endoscopic tympanoplasty in the treatment of chronic otitis media: our experience.

Panetti, G. et al. (2017) Acta Oto-Laryngologica. 137(3) pp. 225-228.

Objectives: To investigate the benefits that the systematic use of endoscopy in middle ear surgery has made.

Conclusion: The endoscopy ensures good surgical exposure of hidden areas, frequently sites of residual cholesteatoma. Also, the minimally invasive endoscopic approach is more respectful of anatomy and functionality of the middle ear, restoring and preserving mastoid mucosa, with faster healing time.

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Successful obliteration of troublesome and chronically draining cavities

Geerse, S. et al. (2017) The Journal of Laryngology & Otology. 131(2) pp. 138-143

This study aimed to evaluate the results of revision radical cavity surgery with mastoid obliteration using a standardised grading scheme.

A retrospective study was performed of 121 patients (122 ears) with chronically draining ears who underwent revision radical cavity surgery with mastoid obliteration between 2007 and 2013. Surgical indications, patient characteristics, pre- and post-operative Merchant grade, and surgical outcomes were recorded. The main outcome measures were presence of a dry ear, time for complete re-epithelialisation, presence of residual or recurrent disease, and need for revision surgery.

In the 5-year follow-up group (n = 31), dry ears were found in 97 per cent after 6 minor revisions and cholesteatoma-free ears were found in 97 per cent. In the total cohort, dry ears were found in 93 per cent after nine revisions and cholesteatoma-free ears were found in 98 per cent. The median time for complete re-epithelialisation was eight weeks. There were no major complications.

In terms of the dry ear rate, residual cholesteatoma and time to complete epithelialisation, revision radical cavity surgery with mastoid obliteration produces very good results in concordance with published results, despite most patients suffering from very troublesome cavities prior to surgery.

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