Mastoid

UnlabelledMiddle ear cholesteatoma is an important and relatively common disorder which may have serious consequences.AimThe purpose was to conduct a retrospective study of the statistics of 1,146 middle ear surgical procedures for middle ear cholesteatoma in adults and children of low income living in distant areas from our city.MethodsFrom 1962 to 1988 there were 1,146 surgeries for unilateral or bilateral cholesteatomas in children and adults, which were reviewed for the following criteria: total number of surgeries, sex, onset of the first symptoms, duration of the disease, the site of perforation, the cholesteatoma site, changes in the ossicular chain, the contralateral ear, bilateral cholesteatomas, the site of residual cholesteatoma, and complications.ResultsResults are shown graphically on a pie chart.ConclusionThe etiology of cholesteatomas remains unknown. Epidemiological and statistical data, surgical reports, and conclusions of experimental studies are welcome, as they may provide support for clarifying the pathogenesis of cholesteatoma. Our results were compared with internationally published papers. We found no published papers on the epidemiology of cholesteatoma in the Brazilian literature.

BackgroundA mastoid cavity resulting from a canal wall down mastoidectomy can result in major morbidity for patients due to chronic otorrhea and infection, difficulty with hearing aids and vertigo with temperature changes. Mastoid obliteration with reconstruction of the bony external ear canal recreates the normal anatomy to avoid such morbidity. Few have the studied the quality of life benefit that this procedure confers.MethodsThis retrospective observational study was conducted to determine if mastoid obliteration with autologous cranial bone graft following mastoidectomy improves quality of life (QOL). Patients with cholesteatoma who had mastoidectomy with primary or secondary mastoid obliteration by a tertiary otologist were surveyed using the validated Glasgow Benefit Inventory (GBI), our primary outcome measure.ResultsFifty-eight patients were interviewed. Forty-six were primary obliteration after canal wall down mastoidectomy of a primary cholesteatoma. Twelve were secondary obliteration of an existing canal wall down mastoid cavity. Overall GBI scores were improved, with average scores of 22. Average general subscale scores were 23, physical health scores were 25, and social health scores were 22. The primary obliteration group had average scores of 19, general subscale scores of 20, physical health scores of 21, and social health scores of 22. Those with secondary obliteration scored higher, with average scores of 31, general subscale scores of 34, physical health scores of 39, and social health scores of 25.ConclusionThis study shows that mastoidectomy with obliteration using autologous cranial bone graft offers a significant QOL benefit. The GBI scores compare favourably with other otorhinolaryngology procedures. Secondary obliterations after revision mastoidectomy scored much higher than primary obliterations. This is currently the only QOL study comparing these two patient groups.

Cholesteatoma is a progressive middle ear disease that can only be treated surgically but with a high recurrence rate. Depending on the extent of the disease, a surgical approach, such as microsurgery with a retroarticular incision or transcanal endoscopic surgery, is performed. However, the current examination cannot sufficiently predict the progression before surgery, and changes in approach may be made during the surgery. Large amounts of data are typically required to train deep neural network models; however, the prevalence of cholesteatomas is low (1-in-25, 000). Developing analysis methods that improve the accuracy with such a small number of samples is an important issue for medical artificial intelligence (AI) research. This paper presents an AI-based system to automatically detect mastoid extensions using CT. This retrospective study included 164 patients (80 with mastoid extension and 84 without mastoid extension) who underwent surgery. This study adopted a relatively lightweight neural network model called MobileNetV2 to learn and predict the CT images of 164 patients. The training was performed with eight divided groups for cross-validation and was performed 24 times with each of the eight groups to verify accuracy fluctuations caused by randomly augmented learning. An evaluation was performed by each of the 24 single-trained models, and 24 sets of ensemble predictions with 23 models for 100% original size images and 400% zoomed images. Fifteen otolaryngologists diagnosed the images and compared the results. The average accuracy of predicting 400% zoomed images using ensemble prediction model was 81.14% (sensitivity = 84.95%, specificity = 77.33%). The average accuracy of the otolaryngologists was 73.41% (sensitivity, 83.17%; specificity, 64.13%), which was not affected by their clinical experiences. Noteworthily, despite the small number of cases, we were able to create a highly accurate AI. These findings represent an important first step in the automatic diagnosis of the cholesteatoma extension.

Osteomas of the temporal bone are rare benign tumors that, in a small minority of cases, may give rise to secondary cholesteatoma. We report a case in which two independent pathological mechanisms appeared to coexist, resulting in a configuration not previously described in the literature. A 51-year-old woman presented with one year of right-sided otorrhoea and progressive mixed hearing loss unresponsive to antibiotic therapy. High-resolution computed tomography (HRCT) demonstrated a giant sessile osteoma arising from the anterior mastoid cortex with complete external auditory canal (EAC) obstruction. Non-echo-planar diffusion-weighted MRI (non-EPI DWI-MRI) identified cholesteatoma restricted to the middle ear and mastoid antrum, clearly distinct from chronically inflamed mastoid air cells. Intraoperatively, a near-intact tympanic membrane with a small attic retraction pocket formed the anterior boundary; no canal-wall cholesteatoma was present. Canal wall-down (CWD) radical mastoidectomy with osteoma excision and meatoconchoplasty achieved complete disease eradication. Histopathology confirmed compact osteoma and cholesteatoma. The cavity was dry and stable at the three-month follow-up. Upon review of the published case reports of temporal bone osteoma with associated cholesteatoma, no previously reported case combined a giant osteoma of the anterior mastoid cortex with cholesteatoma confined entirely to the middle ear and mastoid behind a structurally preserved tympanic membrane. The intraoperative finding of an attic retraction pocket suggests that Eustachian tube dysfunction may have played an independent contributory role alongside the osteoma. Combined HRCT and non-EPI DWI-MRI was essential for preoperative characterization and surgical planning.