暂无摘要。

BACKGROUND: Transcanal endoscopic ear surgery (TEES) has become popular in recent years in the treatment of glomus tympanicum tumors (GTT). The most significant risk for TEES is bleeding. In some cases, preoperative vascular embolization is performed to mitigate bleeding during TEES. However, guidelines regarding the necessity and efficacy of preoperative vascular embolization have not been established yet.
METHODS: This report aimed to assess the necessity and usefulness of preoperative vascular embolization in TEES for GTT by comparing the surgical findings of TEES without preoperative vascular embolization (Case 1) and TEES with preoperative vascular embolization (Case 2). Compared to Case 1, Case 2 included less bleeding and a more convenient procedure. However, no significant difference was observed.
CONCLUSIONS: For GTT confined to the middle ear cavity (Glasscock-Jackson Grade II or less), when performed by a proficient otolaryngologist, TEES alone is sufficient without preoperative vascular embolization.

Transcanal endoscopic ear surgery (TEES) provides wide-angle clear vision for otologic surgery. We report the utility of TEES with the mirror technique for the complete removal of a congenital cholesteatoma in a 3-year-old boy. A white mass was observed through the tympanic membrane, and a congenital cholesteatoma was suspected during the conservative treatment of otitis media with effusion. Pre-operative computed tomography (CT) revealed an irregular mass lesion in the left middle ear, with bone erosion in the hypotympanum. During surgery, an open-type cholesteatoma was observed, mainly in the middle lower tympanum. The cholesteatoma had destroyed the periphery of the temporomandibular joint, which was widely exposed. The cholesteatoma had also spread to the tympanic sinus. Careful observation with a forward-oblique viewing endoscope and a variable angle tympanic mirror enabled complete removal of the mass under endoscopic guidance. No recurrence was observed during the postoperative follow-up, although residual open-type congenital cholesteatoma may often result in recurrence. We believe that careful removal of the lesion under TEES, which allowed us to perform surgery under a secure view with illumination and magnification, may have facilitated complete removal and prevented recurrence.

Transcanal endoscopic ear surgery is a minimally invasive procedure that allows a clear visualization of the middle ear. Recently, indications for endoscopic surgery have been expanding. We performed combined underwater endoscopic and microscopic surgery for external auditory canal cholesteatoma, the computer tomography of which indicates the possibility of cholesteatoma not only in the canal wall but also in the mastoid. The 30° endoscope and underwater technique makes the surgical view clear, and we could remove the cholesteatoma without canalplasty. To the best of our knowledge, no case of external auditory canal cholesteatoma treated with underwater endoscopic and microscopic surgery has been previously reported. This case indicates that the procedure could be a good indication for external auditory canal cholesteatoma.

To assess whether day-case major otologic ear surgery is a safe and feasible alternative to inpatient surgery, while maintaining equal complication rates, and to identify causes of admission after day-case surgery.
PubMed, Embase, and Cochrane.
A systematic search was conducted. Studies reporting original data on the effect of day-case ear surgery on admission rate, patient satisfaction, and/or postoperative complications were included. Risk of bias of the selected articles was assessed using criteria based on the Cochrane Collaboration\'s tool for assessing risk of bias.
A total of 1,734 unique studies were retrieved of which 35 articles discussing 34 studies were eligible for data extraction. The admission rates ranged from 0% to 88% following day-case endaural surgery, 0% to 13% following day-case stapes surgery, 0% to 82% following day-case mastoid surgery, and 0% to 15% following day-case cochlear implant surgery. Patient and parent satisfaction regarding day-case surgery ranged from 67% to 99%. Five studies comparing day-case and inpatient otologic surgery showed no difference in hearing outcome, postoperative complications, or patient satisfaction.
The highest pooled admission rate was seen following day-case mastoid surgery. Studies comparing day-case and inpatient care suggest hearing results and postoperative complication rates in day-case otologic surgery are similar to inpatient otologic surgery in both children and adults. Therefore, day-case major otologic surgery seems to be a safe and feasible alternative to inpatient surgery for both children and adults.

UNASSIGNED: The presence of an aberrant internal carotid artery (ICA) in the middle ear is rare. Patients may be asymptomatic or complain of conductive hearing loss, otalgia, pulsatile tinnitus, or aural fullness. Otoscopic exam findings can include a pulsating erythematous lesion on the tympanic membrane (TM). It may be misdiagnosed as a glomus tumor, hemangioma, or serous otitis media, or go unrecognized until surgical exploration. Early recognition is important as intraoperative discovery carries risk of iatrogenic injury, hemorrhage and subsequent neurologic sequelae. Prevention requires adequate preoperative suspicion and can be confirmed with radiologic examination via computed tomography (CT) scan or magnetic resonance angiography (MRA). Management of iatrogenic injury of an aberrant ICA can include packing, vessel embolization and/or surgical ligation.
UNASSIGNED: We report the case of an aberrant ICA injury in a pediatric patient undergoing a myringotomy with tube placement, who sustained neurologic deficits that eventually resolved following treatment with packing and coil embolization.
UNASSIGNED: An aberrant ICA can cause life-threatening complications without prior diagnosis in a routine myringotomy. Suspicious exam findings should prompt temporal bone CT to rule out aberrant ICA or other vascular pathology of the middle ear prior to surgery. In the case of iatrogenic injury of an aberrant ICA, there is no consensus in existing literature on optimal management. We reviewed 37 studies to compare therapeutic options and subsequent outcomes. Though complications are rare regardless of management, cases in which solely packing was utilized demonstrated an increased incidence of hemiparesis, aphasia, hearing loss, re-bleeding, and delayed pseudoaneurysm, as compared to an approach coupling packing with embolization or ligation, both of which have comparable outcomes.

OBJECTIVE: The objective of this multicenter retrospective case review was to assess the natural clinical course, efficacy, and safety of mastoid obliteration with S53P4 Bioactive Glass (bioactive glass).
METHODS: Retrospective case note review in a regional Tertiary Referral Centre and District General Hospital. Patients undergoing mastoid cavity obliteration as part of primary or secondary procedure with bioactive glass between 2012 and 2018. Outcome measures were assessed from a prospectively collated database and case note review. Primary outcomes were the common morbidities of a mastoid cavity; dry or discharging ear (Merchant\'s scale), vertigo in cold air, and a watertight middle ear. Patients were also assessed for audiological outcomes and recidivism.
RESULTS: Ninety patients were included. During the follow-up period, (mean, 22 months; range, 6-59 months) cholesteatoma recidivism was observed in 2% of ears (2 patients). An acceptably dry (Merchant Grade 0-1) ear was achieved in 91% of all ears (95% primary cases, 80% secondary cases). Delayed healing of the graft in the external ear canal retaining the S53P4BAG Bioactive Glass (BonAlive Ò (BonAlive Ò Biomaterials Ltd., Turku, Finland)) within the mastoid occurred in 13% (12 ears). However, in all cases, conservative management resulted in complete healing.
CONCLUSIONS: Bioactive glass provides a safe and effective means of mastoid obliteration. Complications including overlay graft failure and slow epithelialization, resulting in prolonged postoperative discharge (up to 2 months) and dehiscence into the external ear canal, do not preclude full recovery and may be successfully managed conservatively.

A dehiscent high jugular bulb would be a pitfall in middle ear surgery especially for cholesteatoma. We report a case of cholesteatoma attached to a dehiscent high jugular bulb successfully treated with surgery assisted with underwater endoscopy. To the best of our knowledge, no previous study has reported a case of cholesteatoma with dehiscent high jugular bulb treated with surgery assisted with underwater endoscopy. Owing to the risk of jugular bulb injury, underwater endoscopy is a good indication for middle ear cases with a dehiscent high jugular bulb to obtain a clear operative field and avoid an unexpected air embolism.

Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality. This study explores integration of OpenEar datasets into VES to enable case variation in simulation with implications for patient-specific modeling based on CBCT.
The OpenEar dataset consists of segmented, coregistered, multimodal imaging sets of human temporal bones. We derived drillable bone segments from the dataset as well as triangulated surface models of critical structures such as facial nerve or dura. Realistic visualization was achieved using coloring from micro-slicing, custom tinting, and texture maps. Resulting models were validated by clinical experts.
Six of the eight OpenEar datasets could be integrated in VES complete with instructional guides for various temporal bone surgical procedures. Resulting models were of high quality because of postprocessing steps taken to increase realism including colorization and imaging artifact removal. Bone artifacts were common in CBCT, resulting in dehiscences that most often could not be found in the ground truth micro-slicing data.
New anatomy models are included in VES version 3.5 freeware and provide case variation for training which could help trainees to learn more quickly and transferably under variable practice conditions. The use of CBCT for VR simulation models without postprocessing results in bone artifacts, which should be considered when using clinical imaging for patient-specific simulation, surgical rehearsal, and planning.

UNASSIGNED: As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored.
UNASSIGNED: This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach.
UNASSIGNED: The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty via transcannal approach were analyzed.
UNASSIGNED: The average air-bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different.
UNASSIGNED: Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption.