Evaluation of Subtotal Petrosectomy Technique in Difficult Cases of Cochlear Implantation

2020 ◽  
Vol 25 (6) ◽  
pp. 323-335
Author(s):  
Golda Grinblat ◽  
Diana Vlad ◽  
Antonio Caruso ◽  
Mario Sanna
Keyword(s):  
Chronic Otitis Media ◽  
Wound Dehiscence ◽  
Single Stage ◽  
Mastoid Cavity ◽  
Mastoid Obliteration ◽  
Subtotal Petrosectomy ◽  
Ear Malformations ◽  
Middle Ear Disease ◽  
Cochlear Ossification ◽  
Blind Sac Closure

<b><i>Objectives:</i></b> To assess the validity of the subtotal petrosectomy (STP) technique in problematic cases of cochlear implant (CI) surgery, and review indications, outcomes, and related controversies. <b><i>Study Design:</i></b> This is a retrospective review of data from a private quaternary referral center of otology and skull base surgery. <b><i>Patients and Methods:</i></b> A review of patients who underwent CI with STP (STP-CI) as the leading approach was performed. Demographics, indications, surgical details, and main outcomes were evaluated. The surgeries performed were usually single-stage procedures encompassing a comprehensive mastoidectomy, blind sac closure of the external auditory canal (EAC), and mastoid obliteration with autologous fat. <b><i>Results:</i></b> A total of 107 cases were included. Mean follow-up was 7.1 years (range 1–13 years). The most frequent indication for STP-CI was chronic otitis media with/without cholesteatoma (32.7%), followed by open mastoid cavity (26.1%), and cochlear ossification (17.7%). Other difficult conditions where STP facilitates successful implantation include inner-ear malformations, temporal-bone trauma, unfavorable anatomic conditions, and revision surgery. A planned staged procedure was performed in 3 cases. The rate of major complications was 5.6% (<i>n</i> = 6). Three patients developed postauricular wound dehiscence which eventually resulted in device extrusion. No cases of recurrent/entrapped cholesteatoma, EAC breakdown, or meningitis were encountered. This is the largest single-center series of STP-CI reported in the literature. <b><i>Conclusions:</i></b> When CI is intended in technically challenging cases or associated with a high risk of complications, STP is effective and reliable. Safe implantation and excellent long-term outcomes can be achieved provided surgical steps are properly followed. Single-stage procedures can be performed in most cases, even when there is active middle-ear disease.

scholarly journals Single stage cochlear implantation in radical mastoid cavity- a surgical dilemma

2020 ◽  
Vol 12 (3) ◽  
pp. 102-106
Author(s):  
Naresh K Panda ◽  
Gyanaranjan Nayak ◽  
Roshan Verma
Keyword(s):  
Cochlear Implantation ◽  
Electrode Array ◽  
Complete Removal ◽  
Single Stage ◽  
Mastoid Cavity ◽  
Epithelial Lining ◽  
Blind Sac Closure ◽  
Cavity Obliteration ◽  
Temporoparietal Fascia Flap

Objective: To describe the potential problems of cochlear implantation in mastoid cavity with possibilities of extrusion of electrode array by breakdown of epithelial lining or flap cover recurrent cholesteatoma and spread of infection to the implant. The issues with surgical management and subsequent follow up is discussed. Methods: In a Series of 170 Cochlear Implantations at our centre, four patients had Cochlear Implantation with Blind sac closure, complete removal of epithelium from the radical mastoid cavity, obliteration of the cavity with temporoparietal fascia flap and electrode insertion. Follow up ranging from 21 months up to 84 months is available. One patient during follow up had to undergo re implantation due to extrusion of the electrodes. Results: All the patients had good outcome regarding hearing improvement. One of the patients had to undergo exploration and re implantation of electrodes due to extrusion of electrodes through the external auditory canal. This patient had a canal cholesteatoma. Discussion: An important issue in single stage procedure is ensuring complete removal of fibro epithelial lining of the cavity. The advantage is cost reduction and minimizes the need for multiple general anesthesia. A follow up CT scan at regular intervals is required to detect recurrence. Conclusions: The patients undergoing cochlear implantation in a radical mastoid cavity require intensive follow up with computerized tomography to detect recidivism, Single stage cochlear implantation in radical mastoid cavity is an appropriate therapeutic decision by the cochlear implant surgeon.

The role of subtotal petrosectomy in cochlear implantation

2016 ◽  
Vol 130 (S4) ◽  
pp. S35-S40 ◽  
Author(s):  
P Casserly ◽  
P L Friedland ◽  
M D Atlas
Keyword(s):  
Otitis Media ◽  
Cochlear Implantation ◽  
Chronic Otitis Media ◽  
External Auditory Meatus ◽  
Suppurative Otitis Media ◽  
Surgical Access ◽  
Subtotal Petrosectomy ◽  
Blind Sac Closure ◽  
Cavity Obliteration ◽  
Radical Cavity

AbstractBackground:Subtotal petrosectomy combined with cochlear implantation is a procedure required in specific situations.Methods:A retrospective review of all cases of subtotal petrosectomy in cochlear implant surgery over a five-year period was performed. The indications, complications and outcomes for this procedure are outlined.Results:Sixteen patients underwent cochlear implantation in combination with subtotal petrosectomy and blind sac closure of the external auditory meatus from 2008 to 2013. Seventy-five per cent of these were completed as a two-stage procedure and 25 per cent as a single-stage procedure. The most common indications for the procedure were chronic otitis media, previous radical cavity, and for surgical access in challenging anatomy or in drill-out procedures. Mastoids were obliterated with fat or musculoperiosteal flaps. The complication rate relating to blind sac closure was 6 per cent. Cochlear implants were successfully placed in all cases and there was no incidence of device failure.Conclusion:For patients with chronic suppurative otitis media or existing mastoid cavities, subtotal petrosectomy with blind sac closure of the external auditory canal, closure of the eustachian tube, and cavity obliteration is an effective technique to facilitate safe cochlear implantation.

The importance of petrous apex and peri-carotid pneumatisation in subtotal petrosectomy and blind sac closure: a radiological study

2018 ◽  
Vol 132 (8) ◽  
pp. 698-702 ◽  
Author(s):  
I McKay-Davies ◽  
K Selvarajah ◽  
M Neeff ◽  
H Sillars
Keyword(s):  
Carotid Artery ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Chronic Otitis Media ◽  
Petrous Apex ◽  
Tertiary Referral Centre ◽  
Subtotal Petrosectomy ◽  
Blind Sac Closure ◽  
Temporal Bones ◽  
Communication Pathway

AbstractObjectiveTo ascertain in what proportion the vertical segment of the intratemporal carotid artery on its medial aspect anatomically separates the peri-tubal cells and Eustachian tube from the remainder of the pneumatised spaces of the temporal bone.MethodA retrospective review was conducted of 222 adult and 29 paediatric consecutive computed tomography scans of petrous temporal bones from a single tertiary referral centre.ResultsIn 96 per cent of temporal bones, the carotid artery formed a lateral barrier (with no communication pathway medially) between air spaces anterior and posterior to it. This equated to 94 per cent when chronic otitis media cases were excluded.ConclusionThe degree of separation of middle-ear air cells from the Eustachian tube or nasopharynx, and the relevant anatomy, are reviewed. This knowledge helps to optimise the outcome of subtotal petrosectomy and blind sac closure. The frequency and process of pneumatisation of the petrous apex, and its connections with the middle ear, have been radiologically confirmed.

Subtotal petrosectomy with external canal overclosure in the management of chronic suppurative otitis media

1994 ◽  
Vol 108 (3) ◽  
pp. 197-201 ◽  
Author(s):  
Abhi A. Parikh ◽  
Gerald B. Brookes
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Chronic Suppurative Otitis Media ◽  
Mastoid Cavity ◽  
Suppurative Otitis Media ◽  
Additional Advantage ◽  
Regular Care ◽  
Subtotal Petrosectomy ◽  
External Canal ◽  
End Stage

AbstractSubtotal petrosectomy with external canal overclosure has been used in the management of 10 patients with chronic suppurative otitis media in the past four years. These patients fall into two categories. One group consisted of patients with end-stage chronically discharging mastoid cavities, despite aggressive medical therapy. The other group comprised patients who had developed disabling peripheral vestibular symptoms and had a mastoid cavity from past surgery for chronic otitis media. In both groups the affected ear had absent or poor auditory function. In the second group, a translabyrinthine section of the vestibular and/or cochlear nerves was performed in conjunction with subtotal petrosectomyThe procedure has been very successful in relieving the persistent otorrhoea, giving the patient an ear without a cavity that would need regular care. No restriction on swimming and participation in other water sports is an additional advantage.Illustrative cases are used to discuss the technique and indications.

Mastoid cavity obliteration using bone pâté versus bioactive glass granules in the management of chronic otitis media (squamous disease): a prospective comparative study

2021 ◽  
pp. 1-9
Author(s):  
A K Mishra ◽  
A Mallick ◽  
J R Galagali ◽  
A Gupta ◽  
A Sethi ◽  
...  
Keyword(s):  
Bioactive Glass ◽  
Tertiary Care ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Tertiary Care Centre ◽  
Mastoid Obliteration ◽  
Glasgow Benefit Inventory ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean

Abstract Objective To compare the efficacy of bone pâté versus bioactive glass in mastoid obliteration. Method This randomised parallel groups study was conducted at a tertiary care centre between September 2017 and August 2019. Sixty-eight patients, 33 males and 35 females, aged 12–56 years, randomly underwent single-stage canal wall down mastoidectomy with mastoid obliteration using either bone pâté (n = 35) or bioactive glass (n = 33), and were evaluated 12 months after the operation. Results A dry epithelised cavity (Merchant's grade 0 or 1) was achieved in 65 patients (95.59 per cent). Three patients (4.41 per cent) showed recidivism. The mean air–bone gap decreased to 16.80 ± 4.23 dB from 35.10 ± 5.21 dB pre-operatively. The mean Glasgow Benefit Inventory score was 30.02 ± 8.23. There was no significant difference between the two groups in these outcomes. However, the duration of surgery was shorter in the bioactive glass group (156.87 ± 7.83 vs 162.28 ± 8.74 minutes; p = 0.01). Conclusion The efficacy of both materials was comparable.

scholarly journals Implantation of the Bonebridge BCI 602 after Mastoid Obliteration with S53P4 Bioactive Glass: A Safe Method of Treating Difficult Anatomical Conditions-Preliminary Results

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 374
Author(s):  
Bartłomiej Król ◽  
Katarzyna Beata Cywka ◽  
Magdalena Beata Skarżyńska ◽  
Piotr Henryk Skarżyński
Keyword(s):  
Postoperative Complications ◽  
Bioactive Glass ◽  
Bacterial Flora ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Mastoid Obliteration ◽  
Patient’S Satisfaction ◽  
Preliminary Results ◽  
The Impact

This study presents the preliminary results of a new otosurgical method in patients after canal wall down (CWD) surgery; it involves the implantation of the Bonebridge BCI 602 implant after obliteration of the mastoid cavity with S53P4 bioactive glass. The study involved eight adult patients who had a history of chronic otitis media with cholesteatoma in one or both ears and who had had prior radical surgery. The mean follow-up period was 12 months, with routine follow-up visits according to the schedule. The analysis had two aspects: a surgical aspect in terms of healing, development of bacterial flora, the impact on the inner ear or labyrinth, recurrence of cholesteatoma, and possible postoperative complications (firstly, after obliteration of the mastoid cavity with S53P4 bioactive glass, then after implantation). The second was an audiological aspect which assessed audiometric results and the patient’s satisfaction based on questionnaires. During the follow-up period, we did not notice any serious postoperative complications. Studies demonstrated significantly improved hearing thresholds and speech recognition in quiet and noise using the Bonebridge BCI 602. Data collected after six months of use showed improved audiological thresholds and patient satisfaction. Based on the preliminary results, we believe that the proposed two-stage surgical method using bioactive glass S53P4 is a safe and effective way of implanting the Bonebridge BCI 602 in difficult anatomical conditions. This makes it possible to treat a larger group of patients with the device.

Comparison of Hearing Results by Type of Tympanoplasty with Mastoid Obliteration during Chronic Otitis Media Surgery

2009 ◽  
Vol 45 (2) ◽  
pp. 122
Author(s):  
Jeong Uk Choi ◽  
Seung Eun Oh ◽  
Dong Hoon Lee ◽  
Yong Bum Cho ◽  
Hyong Ho Cho
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Mastoid Obliteration ◽  
Hearing Results

scholarly journals Hearing results in modified radical mastoidectomy with type III tympanoplasty

2019 ◽  
Vol 5 (6) ◽  
pp. 1629
Author(s):  
Yash D. Lavana ◽  
Ajay J. Panchal ◽  
Vaibhav B. Hapalia ◽  
Manit M. Mandal ◽  
Shivani D. Shah
Keyword(s):  
Chronic Otitis Media ◽  
Ossicular Chain ◽  
Septal Cartilage ◽  
Mastoid Cavity ◽  
Head Group ◽  
Care Hospital ◽  
Modified Radical Mastoidectomy ◽  
Group A ◽  
The Mean ◽  
Group B

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10<sup>th</sup> week and 24<sup>th</sup> week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017.  </p><p class="abstract"><strong>Results:</strong> In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (p&lt;0.001). Among 86 patients, cartilage was used in total 60 patients. Mean ABG was 8.6 dB, 11.05 dB and 8.43 dB respectively for tragal, conchal and homologous septal cartilage.  </p><p class="abstract"><strong>Conclusions:</strong> Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.</p>

scholarly journals Chronic otitis media progressing to temporal bone osteomyelitis and sequestration with mastoid cavity myiasis in paediatric age group: an unusual case report

2020 ◽  
Vol 6 (5) ◽  
pp. 1001
Author(s):  
Prashanth Kudure Basavaraj ◽  
Manjunatha H. Anandappa ◽  
Nishtha Sharma ◽  
Shreyas Karkala ◽  
Veena Prabhakaran
Keyword(s):  
Temporal Bone ◽  
Otitis Media ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Modified Radical Mastoidectomy ◽  
Paediatric Age ◽  
History Of ◽  
Human Ear ◽  
High Degree ◽  
Unusual Case Report

<p>Myiasis is the infestation by fly larvae. There are few sporadic publications regarding human ear myiasis. Osteomyelitis of temporal bone is also an uncommon entity. This study aims to describe the clinical presentation and management of a unique presentation of mastoid cavity myiasis and sequestration in a 4 year old child, who presented to Chigateri district hospital, Davangere with blood tinged discharge along with visible maggots from left external auditory canal and post auricular sinus since 3 days, with history of chronic otitis media. After manual cleaning of maggots, high resonance computed tomography of temporal bone was done, which showed findings suggestive of foreign body with bony density. Modified radical mastoidectomy was done, where osteomyelitis of temporal bone with sequestrum was encountered on table and removed. Diagnosis of temporal bone osteomyelitis requires a high degree of suspicion, especially in a setting of myiasis, as these 2 rare pathologies have not been reported to co-occur in literature. Early intervention is essential to avoid fatal complications of this infrequent presentation.</p>

S224 – Efficacy of Long Silastic Sheet in COM Surgery

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P150-P150
Author(s):  
Hyong-Ho Cho ◽  
Hyun-Seok Choi ◽  
Chul-Ho Jang ◽  
Yong-Bum Cho
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Valsalva Maneuver ◽  
Chronic Otitis Media ◽  
Mastoid Cavity ◽  
Middle Ear Mucosa ◽  
Hearing Result ◽  
Staged Operation ◽  
Canal Wall Up

Objectives To determine the effect of long silastic sheet for middle ear aeration in chronic otitis media surgery. Methods Between January 2003 and May 2007, 46 patients underwent planned staged canal wall up tympanomastoidetomy, because possibility of residual cholesteatoma and severe swelling middle ear mucosa, especially around the stapes. Long silastic sheet was inserted from mastoid cavity to middle ear via facial recess during operation procedure. To determine the effect of long silastic sheet for recovery of mastoid aeration, various factors such as computed tomography grading, Valsalva maneuver grading for Eustachian function, and hearing result were compared. Results During the average follow-up of 31 months, there was 1 recurred chronic otitis media which was revealed tuberculosis otitis media. Intact tympanic membrane was obtained in 45(97.8%) of 46 patients. In CT grading, middle ear aeration was increased significantly (p<0.05). Air-Bone gap was significantly decreased after staged operation, preoperative average ABG was 29.7dB and last average ABG was 21.0dB (p <0.05). But Eustachian function using Valsalva manerver was not significantly changed (p >0.05). Conclusions Long silastic sheet insertion from mastoid to middle ear is statistically effective for amelioration of middle ear and mastoid aeration after the first-stage operation.

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