Introduction: Middle ear surgery is increasingly performed in our department. Our goal was to take stock of this activity in the ENT department of the Donka National Hospital. Equipment and Methods: It was a descripti...Introduction: Middle ear surgery is increasingly performed in our department. Our goal was to take stock of this activity in the ENT department of the Donka National Hospital. Equipment and Methods: It was a descriptive and retrospective study;it involved 71 patients’ records operated from January 1, 2018 to December 31, 2023. We included the files of patients who had a middle ear surgery including the post-operative report and follow-up. Incomplete or illegible records were excluded. The parameters studied were epidemiological, otoscopic, tomodensitometric, surgical indications, surgical techniques and results. Results: We recorded 71 middle ear surgeries out of 548 ENT surgeries, the prevalence was 12.96%. The average age was 23 years (type-deviation = 17, 29 years) with extremes of 3 to 75 years. According to the preoperative audiometry, the deafness was medium (48.8%), mild (36.9%) and severe (14.3%). The operative indications were among others: perforation of the tympanic sequellar (52.5%), chronic otomastoiditis (23.8%), cholesteatoma (15%) and seromuqueous otitis (8.7%). We performed 70 tympanoplasties (90.9%), 50 mastoidectomies (64.9%) and 7 trans-tympanic aerators (9.1%). One month after surgery, the neotympanum was constituted in 86%, and the hearing gain was between 11 and 15 dB in 18.3% of cases. Conclusion: Middle ear surgery was infrequent. Young subjects are the most concerned. Tympanoplasty and mastoidectomy are the main surgical techniques. The anatomical and functional results are appreciable.展开更多
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,a...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.展开更多
Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and...Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.展开更多
BACKGROUND Endoscopic ear surgery(EES)provides a magnified,high-definition view of the otological surgical field.EES allows otologists to avoid surgical incisions and associated postoperative complications.It is an id...BACKGROUND Endoscopic ear surgery(EES)provides a magnified,high-definition view of the otological surgical field.EES allows otologists to avoid surgical incisions and associated postoperative complications.It is an ideal technique for the perfor-mance and teaching of tympanoplasty.AIM To examine the efficacy of total Endoscopic Push Through Tragal Cartilage Tympanoplasty(EPTTCT),at our institution over a 10-year period.METHODS A retrospective analysis of 168 cases of EPTTCT for closure of small to medium tympanic membrane perforations from 2013-2023 was conducted.Patient sex,age range(pediatric vs adult),etiology of injury,success rate,complications,and postoperative hearing status were collected.RESULTS Graft uptake results indicated success in 94%of patients,with less than a 2%complication rate.Postoperative pure tone audiometry demonstrated hearing status improvement in 69%of patients.CONCLUSION EPTTCT has been shown to be effective in tympanic membrane perforation closures with minimal complications.This study further demonstrates the efficacy and safety of these procedures in a single-center review.展开更多
Objectives:This article reviews the advantages and disadvantages of endoscopic ear surgery(EES).Method:Pubmed,Google and the Proquest Central Database at Kirikkale University were queried using the keywords"endos...Objectives:This article reviews the advantages and disadvantages of endoscopic ear surgery(EES).Method:Pubmed,Google and the Proquest Central Database at Kirikkale University were queried using the keywords"endoscopic ear surgery","ear surgery"and"endoscopy"to identify the literature needed for the review.Results:Endoscopes allow for enhanced surgical visualisation.The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area.Transcanal endoscopic techniques have transformed the external ear canal(EAC)into an operative gateway.The benefits EES can offer include wider views,enhanced imaging capabilities and increased magnification,and ways to see otherwise poorly visualisable portions of the middle ear.EES permits surgeons to operate using minimally invasive otological techniques.When compared with microscope-assisted surgery,endoscopic tympanoplasty has been shown to require a shorter operating time in some instances.There are a number of drawbacks to EES,however,which include the fact that it is a single-handed technique,that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.Conclusion:EES is a safe and effective technique.The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.展开更多
Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preser...Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.展开更多
Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL) is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most freq...Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL) is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography (ECochG), auditory brainstem response (ABR), auditory steady state response (ASSR), distortion product otoacoustic emissions (DPOAE), subjective whisper test, and optical coherence tomography (OCT). Here, we illustrate several methods used clinically by reviewing the literature.展开更多
Endoscopic ear surgery(EES) is an exciting, rapidly developing and innovative field of otologic surgery.Technically and conceptually, EES is a significant departure from traditional microscopic transcanal approaches t...Endoscopic ear surgery(EES) is an exciting, rapidly developing and innovative field of otologic surgery.Technically and conceptually, EES is a significant departure from traditional microscopic transcanal approaches to the middle ear and canal that has shown very positive results with respect to patient outcomes. This review serves as a primer for the otologist and otology resident embarking on EES and discusses the theory surrounding the learning process, the optical chain for endoscopic surgery as well as other important underlying principles.展开更多
The broad application of virtual reality (VR) to medicine has been of great value. The virtual surgery is one of technically difficult applications. With the expansion of the increasingly fine and complicated ear micr...The broad application of virtual reality (VR) to medicine has been of great value. The virtual surgery is one of technically difficult applications. With the expansion of the increasingly fine and complicated ear microsurgery, new methods are required to train the doctors. It is necessary and of practical significance to apply VR to the ear micro-operation, which is a functional operation with high precision and great difficulties. In this article, medical VR applications were reviewed. The application of VR to the ear microsurgery was discussed and the virtual ear microsurgery system was designed.展开更多
Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a mi...Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.展开更多
文摘Introduction: Middle ear surgery is increasingly performed in our department. Our goal was to take stock of this activity in the ENT department of the Donka National Hospital. Equipment and Methods: It was a descriptive and retrospective study;it involved 71 patients’ records operated from January 1, 2018 to December 31, 2023. We included the files of patients who had a middle ear surgery including the post-operative report and follow-up. Incomplete or illegible records were excluded. The parameters studied were epidemiological, otoscopic, tomodensitometric, surgical indications, surgical techniques and results. Results: We recorded 71 middle ear surgeries out of 548 ENT surgeries, the prevalence was 12.96%. The average age was 23 years (type-deviation = 17, 29 years) with extremes of 3 to 75 years. According to the preoperative audiometry, the deafness was medium (48.8%), mild (36.9%) and severe (14.3%). The operative indications were among others: perforation of the tympanic sequellar (52.5%), chronic otomastoiditis (23.8%), cholesteatoma (15%) and seromuqueous otitis (8.7%). We performed 70 tympanoplasties (90.9%), 50 mastoidectomies (64.9%) and 7 trans-tympanic aerators (9.1%). One month after surgery, the neotympanum was constituted in 86%, and the hearing gain was between 11 and 15 dB in 18.3% of cases. Conclusion: Middle ear surgery was infrequent. Young subjects are the most concerned. Tympanoplasty and mastoidectomy are the main surgical techniques. The anatomical and functional results are appreciable.
文摘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.
文摘Malignant tumors originating from the middle ear are rare. The literature identifies chronic inflammation and Human Papillomavirus (HPV) infection as the most common risk factors. A CT scan to assess bony invasion and an MRI to evaluate soft tissue involvement, depth of invasion, and perineural invasion, followed by a biopsy, are indispensable for diagnosis and treatment. There is no standard treatment for squamous cell carcinoma of the middle ear, however, most reported cases are treated with surgical resection followed by postoperative radiotherapy. Given the challenges of achieving complete surgical excision, radiotherapy plays a crucial role in controlling middle ear cancers, as demonstrated in our case. We present a case of squamous cell carcinoma of the middle ear in a 63-year-old female with a history of chronic suppurative otitis media. The patient underwent a right subtotal petrosectomy without lymph node dissection followed by concurrent chemoradiotherapy. At the one-year follow visit, no recurrence or metastasis was detected.
文摘BACKGROUND Endoscopic ear surgery(EES)provides a magnified,high-definition view of the otological surgical field.EES allows otologists to avoid surgical incisions and associated postoperative complications.It is an ideal technique for the perfor-mance and teaching of tympanoplasty.AIM To examine the efficacy of total Endoscopic Push Through Tragal Cartilage Tympanoplasty(EPTTCT),at our institution over a 10-year period.METHODS A retrospective analysis of 168 cases of EPTTCT for closure of small to medium tympanic membrane perforations from 2013-2023 was conducted.Patient sex,age range(pediatric vs adult),etiology of injury,success rate,complications,and postoperative hearing status were collected.RESULTS Graft uptake results indicated success in 94%of patients,with less than a 2%complication rate.Postoperative pure tone audiometry demonstrated hearing status improvement in 69%of patients.CONCLUSION EPTTCT has been shown to be effective in tympanic membrane perforation closures with minimal complications.This study further demonstrates the efficacy and safety of these procedures in a single-center review.
基金supported by Continuous Education and Scientific Research Association
文摘Objectives:This article reviews the advantages and disadvantages of endoscopic ear surgery(EES).Method:Pubmed,Google and the Proquest Central Database at Kirikkale University were queried using the keywords"endoscopic ear surgery","ear surgery"and"endoscopy"to identify the literature needed for the review.Results:Endoscopes allow for enhanced surgical visualisation.The distal part of the apparatus is illuminated and contains lenses angled to allow a wider view of the operative area.Transcanal endoscopic techniques have transformed the external ear canal(EAC)into an operative gateway.The benefits EES can offer include wider views,enhanced imaging capabilities and increased magnification,and ways to see otherwise poorly visualisable portions of the middle ear.EES permits surgeons to operate using minimally invasive otological techniques.When compared with microscope-assisted surgery,endoscopic tympanoplasty has been shown to require a shorter operating time in some instances.There are a number of drawbacks to EES,however,which include the fact that it is a single-handed technique,that the light source may produce thermal injury and that visualisation using the endoscope is severely curtailed if bleeding is profuse.Conclusion:EES is a safe and effective technique.The current literature supports the idea that the results achieved by endoscopic methods are usually comparably beneficial to results obtained using conventional microscopic methods.
文摘Application of surgical endoscope, used alone or in combination with the surgical microscope, for the operative management of ear and temporal bone conditions may allow improved access and clearance of disease. Preservation of normal structures may also be improved.As the use of this tool is increasing, the need for better understanding of the anatomy of the ear is becoming evident. This is particularly so for endoscopic surgery aiming at removal of lesions involving the infra-cochlear corridor and/or petrous apex.Human temporal bone-derived labyrinth casts(molds), originally made for endolymphatic duct and sac analysis which genuinely represent the membranous labyrinth and its adjacent soft tissues, were morphometrically analyzed in terms of the anatomic relations between structures in and around the infra-cochlear corridor. The distance between the petrous carotid artery(PCA) and the basal turn of the cochlea, the distance between PCA and infra-cochlear vein(ICV)/cochlear aqueduct(CA), and the distance between the lower surface of basal cochlear turn and the point where the carotid artery and jugular vein(JV) meet close to the jugular foramen, were measured to be around 1.3 mm, 6 mm and 8 mm respectively, thus constituting an approximate 6?8 mm2 infra-cochlear corridor. This analysis and further study with larger samples might be helpful for operation via this corridor led to the petrous apex where cholesterol granuloma, cholesteatoma and other lesions are not uncommon.
基金supported by grants from Provincial Natural Science Foundation of Hai Nan (No. 20168349)the Clinical Research Supporting Foundation of PLA General Hospital (2016FC-TSYS-1014)National Basic Research Program of China (973 Program) (No. 2012CB967900) and National Basic Research Program of China (973 Program) (No. 2011CBA01000)
文摘Hearing loss is a condition affecting millions of people worldwide. Conductive hearing loss (CHL) is mainly caused by middle ear diseases. The low frequency area is the pivotal part of speech frequencies and most frequently impaired in patients with CHL. Among various treatments of CHL, middle ear surgery is efficient to improve hearing. However, variable success rates and possible needs for prolonged revision surgery still frustrate both surgeons and patients. Nowadays, increasing numbers of researchers explore various methods to monitor the efficacy of ossicular reconstruction intraoperatively, including electrocochleography (ECochG), auditory brainstem response (ABR), auditory steady state response (ASSR), distortion product otoacoustic emissions (DPOAE), subjective whisper test, and optical coherence tomography (OCT). Here, we illustrate several methods used clinically by reviewing the literature.
文摘Endoscopic ear surgery(EES) is an exciting, rapidly developing and innovative field of otologic surgery.Technically and conceptually, EES is a significant departure from traditional microscopic transcanal approaches to the middle ear and canal that has shown very positive results with respect to patient outcomes. This review serves as a primer for the otologist and otology resident embarking on EES and discusses the theory surrounding the learning process, the optical chain for endoscopic surgery as well as other important underlying principles.
基金The Scientific Research Fund of ShanghaiScience Committee( 0 3 411980 8) and the Science and TechnologySpecial Fund of Pudong New District( PKJ2 0 0 3 -4 1)
文摘The broad application of virtual reality (VR) to medicine has been of great value. The virtual surgery is one of technically difficult applications. With the expansion of the increasingly fine and complicated ear microsurgery, new methods are required to train the doctors. It is necessary and of practical significance to apply VR to the ear micro-operation, which is a functional operation with high precision and great difficulties. In this article, medical VR applications were reviewed. The application of VR to the ear microsurgery was discussed and the virtual ear microsurgery system was designed.
文摘Objective:Endoscope has been used as diagnostic tool for recidivism and as an adjunct to microscopic technique in the management of cholesteatoma.At present transcanal endoscopic ear surgery(TEES)is being used as a minimally invasive alternative for microscopic approach.We aim to evaluate the feasibility,structural,functional and quality of life outcomes of endoscopic technique in middle ear cholesteatoma.Method:This prospective study was conducted at a tertiary care hospital from January 2017 to January 2018 including 32 adult patients who were treated by TEES for middle ear cholesteatoma.Feasibility of endoscopic technique was assessed by the conversion rates,visualization of middle ear structures and complications.Structural outcomes were evaluated in terms of graft uptake at the third month follow-up and presence of residual or recurrent disease.Functional outcomes were evaluated in terms of postoperative air-bone gap closure at third month follow-up.Patient outcomes in terms of post-operative pain,cosmetic score,day of return to daily activities and patient comfort scores were evaluated.The quality of life outcomes were evaluated using chronic ear survey(CES)and short form questionnaire12 version 2(SF-12V2)which are disease specific and general quality of life assessment tools respectively.Result:Out of 32 patients,endoscopic intact canal wall mastoidectomy was done for 28 and endoscopic canal wall down mastoidectomy in 4 patients.One(3.1%)patient had to be converted to microscopic technique.Median follow-up period was 32.8 months(9e46 months).There were no post-operative complications in any of our patients.The mean middle ear structural visibility index score was 8.4±1.4 with the use of zero-degree endoscope.Graft uptake rate at third month follow-up was 100%.Two(6.3%)patients had recurrent disease at 6 months follow-up and were treated by revision endoscopic surgery.The air conduction(51.3±20.2 dB vs.34.5±20.4 dB,p<0.001),and air-bone gap(33.5±11.1 dB vs.16.9±11.8 dB,p<0.001)has been significantly improved.The mean pain score at 0 hours,6 hours and 24 hours after surgery were 2.5/10,1.6/10 and 0.75/10 respectively.At the discharge,the mean patient comfort score was 9.3±0.6 out of 10.Mean cosmetic score was 9.3±0.5 at the third month follow-up.There was significant post-operative improvement in the sub-scale and total scores of CES and SF-12V2.Conclusion:Endoscopic approach to middle ear cholesteatoma is feasible and confers excellent structural,functional as well as patient related quality of life outcomes.
