Matteo Fermi1,2, Till Siggemann3, Claudio Melchiorri4, Marco Bonali1, Laura Niederhauser5, Marco Caversaccio3, Livio Presutti1,2, Lukas Anschuetz3. 1. Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo 71, 41100, Modena, Italy. 2. Otolaryngology Head and Neck Surgery Department, IRCCS Policlinico Sant'Orsola Malpighi, Via Massarenti 9, Bologna, Italy. 3. Department of Otorhinolaryngology Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland. 4. Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo 71, 41100, Modena, Italy. claudio.melchiorri2@gmail.com. 5. Department of Psychology, University of Bern, Bern, Switzerland.
Abstract
OBJECTIVE: This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. METHODS: A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n = 22), combined (n = 35) and microscope exclusive (n = 46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected and persistence or recurrence of the disease assessed. RESULTS: The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of - 6.02 dB HL (95% CI - 8.87 to - 3.16, p < 0.001) between pre-operative and postoperative ABG, without significant effect of surgical technique. During follow-up, no significant differences regarding disease or otorrhea control were observed. Duration of surgery and hospitalization was shorter in the endoscopic cohort without statistical significance. Intra- and postoperative complications were lower in the endoscopic group. CONCLUSION: Revision CWD surgery can take advantage of the endoscope as a minimally invasive exclusive or adjunct tool to traditional microscopic procedures. Outcome measures of endoscopic revision CWD surgery showed anatomic and functional results comparable to those of the microscopic group. The complication rate, the duration of surgery and hospitalization were favorable in the endoscopic group.
OBJECTIVE: This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. METHODS: A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n = 22), combined (n = 35) and microscope exclusive (n = 46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected and persistence or recurrence of the disease assessed. RESULTS: The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of - 6.02 dB HL (95% CI - 8.87 to - 3.16, p < 0.001) between pre-operative and postoperative ABG, without significant effect of surgical technique. During follow-up, no significant differences regarding disease or otorrhea control were observed. Duration of surgery and hospitalization was shorter in the endoscopic cohort without statistical significance. Intra- and postoperative complications were lower in the endoscopic group. CONCLUSION: Revision CWD surgery can take advantage of the endoscope as a minimally invasive exclusive or adjunct tool to traditional microscopic procedures. Outcome measures of endoscopic revision CWD surgery showed anatomic and functional results comparable to those of the microscopic group. The complication rate, the duration of surgery and hospitalization were favorable in the endoscopic group.
Authors: Michael S Cohen; Razan A Basonbul; Samuel R Barber; Elliott D Kozin; Alejandro C Rivas; Daniel J Lee Journal: Laryngoscope Date: 2017-08-07 Impact factor: 3.325
Authors: Kelly G P Kerckhoffs; Maarten B J Kommer; Thom H L van Strien; Simeon J A Visscher; Hanneke Bruijnzeel; Adriana L Smit; Wilko Grolman Journal: Laryngoscope Date: 2015-09-25 Impact factor: 3.325