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Recent Advances in Otitis Media and Cholesteatoma

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 16374

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Prof. Dr. Tetsuya Tono

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Guest Editor

Department of Otolaryngology-Head and Neck Surgery, University of Miyazaki, Miyazaki, Japan
Interests: otology; middle ear diseases; cholesteatoma staging; deafness; otologic surgical procedures; auditory implants

Special Issue Information

Dear Colleagues,

Otitis media describes a diverse spectrum of pathologic conditions that result in inflammation of the middle ear and mastoid cavity. While a bacterial or viral infection and/or eustachian tube dysfunction are traditional key factors in otitis media, more complicated pathophysiological conditions seem to be involved in middle ear cholesteatoma and some newly characterized otitis media, such as eosinophilic otitis media and otitis media with ANCA associated vasculitis.

Although the management of otitis media can vary, classification and staging of disease progression can aid in choosing the most appropriate and definitive treatment modality. Surgery is still the only therapeutic measure in cholesteatoma, usually involving a mastoidectomy and tympanoplasty to repair the tympanic membrane and the ossicles to improve hearing. Recently, auditory implants are becoming new treatment options for hearing rehabilitation after extensive cholesteatoma surgery in patients where conventional middle ear reconstruction is ineffective or impossible.

In this Special Issue, we are inviting original or review articles covering the cellular biology, bacteriology, epidemiology, genetic advances, middle ear mechanics/physiology, temporal bone pathology, imaging technologies, tympanomastoid surgery and hearing rehabilitation in the context of otitis media and cholesteatoma.

Prof. Dr. Tetsuya Tono
Guest Editor

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Keywords

otitis media
cholesteatoma
eustachian tube function
middle ear mechanics/physiology
temporal bone anatomy/pathology
tympanoplasty/mastoidectomy
auditory implants

Published Papers (9 papers)

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Research

10 pages, 1322 KiB

Open AccessArticle

Development of Air Cell System Following Canal Wall Up Mastoidectomy for Pediatric Cholesteatoma

by Yusuke Yamada, Akira Ganaha, Nao Nojiri, Takashi Goto, Kuniyuki Takahashi and Tetsuya Tono

J. Clin. Med. 2024, 13(10), 2934; https://doi.org/10.3390/jcm13102934 - 16 May 2024

Viewed by 533

Abstract

Background: The development of temporal bone pneumatization is related to the postnatal middle ear environment, where the development of air cells is suppressed with otitis media in early childhood. However, whether air cell formation restarts when mastoidectomy is performed during temporal bone pneumatization remains unclear. Herein, we evaluated temporal bone pneumatization after canal wall up (CWU) tympanomastoidectomy for middle ear cholesteatoma in children. Methods: In total, 63 patients, including 29 patients with congenital cholesteatoma (CC) and 34 patients with acquired cholesteatoma (AC), were assessed using a set of pre- and postoperative computed tomography images. The air cells of the temporal bone were divided into five areas: periantral (anterior), periantral (posterior), periantral (medial), peritubal, and petrous apex. The number of areas with air cells before and after surgery was compared to evaluate temporal bone pneumatization after surgery. Results: A total of 63 patients, comprising 29 with CC and 34 with AC (pars flaccida; 23, pars tensa; 7, unclassified; 4), were evaluated. The median age of patients (18 males and 11 females) with CC was 5.0 (range, 2–15 years), while that of the AC group (23 males and 11 females) was 8 (range, 2–15 years). A significant difference in air cell presence was identified in the CC and AC groups after surgery (Mann–Whitney U, p < 0.001 and p = 0.003, respectively). Between the two groups, considerably better postoperative pneumatization was observed in the CC group. A correlation between age at surgery and gain of postoperative air cell area development was identified in the CC group (Spearman’s rank-order correlation coefficient, r = −0.584, p < 0.001). In comparison with the postoperative pneumatization rate of each classified area, the petrous apex area was the lowest in the CC and AC groups. Conclusions: Newly developed air cells were identified in the temporal bones after CWU mastoidectomy for pediatric cholesteatoma. These findings may justify CWU tympanomastoidectomy, at least for younger children and CC patients, who may subsequently develop air cell systems after surgery. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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12 pages, 8792 KiB

Open AccessArticle

Augmented Reality-Assisted Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma

by Keisuke Tsuchida, Masahiro Takahashi, Takara Nakazawa, Sho Kurihara, Kazuhisa Yamamoto, Yutaka Yamamoto and Hiromi Kojima

J. Clin. Med. 2024, 13(6), 1780; https://doi.org/10.3390/jcm13061780 - 20 Mar 2024

Viewed by 840

Abstract

Background: The indications for transcanal endoscopic ear surgery (TEES) for middle ear cholesteatoma have expanded for cases involving mastoid extension. However, TEES is not indicated for all cases with mastoid extension. In addition, predicting the extent of external auditory canal (EAC) removal needed for cholesteatoma resection is not always easy. The purpose of this study was to use augmented reality (AR) to project the lesion onto an intraoperative endoscopic image to predict EAC removal requirements and select an appropriate surgical approach. Methods: In this study, patients showing mastoid extension were operated on using a navigation system with an AR function (Stryker). Results: The results showed that some cases with lesions slightly extending into the antrum required extensive resection of the EAC, while cases with lesions extending throughout the antrum required smaller resection of the EAC, indicating TEES. Conclusions: By predicting the extent of the needed EAC removal, it is possible to determine whether TEES (a retrograde approach) or canal wall-up mastoidectomy, which preserves as much of the EAC as possible, should be performed. We believe that our findings will contribute to the success of middle ear surgeries and the implementation of robotic surgery in the future. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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10 pages, 1540 KiB

Open AccessArticle

Epidemiology of Congenital Cholesteatoma: Surveys of the Last 17 Years in Japan

by Yoshinori Kadowaki, Shinsuke Ide, Takeshi Nakamura, Takumi Okuda, Hideto Shigemi, Takashi Hirano, Kuniyuki Takahashi and Masashi Suzuki

J. Clin. Med. 2024, 13(5), 1276; https://doi.org/10.3390/jcm13051276 - 23 Feb 2024

Viewed by 762

Abstract

(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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13 pages, 1818 KiB

Open AccessArticle

Cholesteatoma Severity Determines the Risk of Recurrent Paediatric Cholesteatoma More Than the Surgical Approach

by Adrian L. James

J. Clin. Med. 2024, 13(3), 836; https://doi.org/10.3390/jcm13030836 - 1 Feb 2024

Cited by 1 | Viewed by 858

Abstract

Objective: To evaluate factors that influence the rate of cholesteatoma recurrence (growth of new retraction cholesteatoma) in children. Methods: Review of children with primary acquired or congenital cholesteatoma. Severity was classified by extent and EAONO-JOS stage, and surgery by SAMEO-ATO. Primary outcome measure was 5-year recurrence rate using Kaplan–Meier or Cox regression analysis. Results: Median age was 10.7 years for 408 cholesteatomas from which 64 recurred. Median follow up was 4.6 years (0–13.5 years) with 5-year recurrence rate of 16% and 10-year of 29%. Congenital cholesteatoma (n = 51) had 15% 5-year recurrence. Of 216 pars tensa cholesteatomas, 5-year recurrence was similar at 14%, whereas recurrence from 100 pars flaccida cholesteatomas was more common at 23% (log-rank, p = 0.001). Sub-division of EAONO-JOS Stage 2 showed more recurrence in those with than without mastoid cholesteatoma (22.1% versus 10%), with more in Stage 3 (31.9%; p = 0.0003). Surgery without mastoidectomy, including totally endoscopic ear surgery, had 11% 5-year recurrence. Canal wall-up tympanomastoidectomy (CWU) and canal wall-down/mastoid obliteration both had 23% 5-year recurrence. Multivariate analysis showed increased recurrence for EAONO-JOS Stage 3 (HR 5.1; CI: 1.4–18.5) at risk syndromes (HR 2.88; 1.1–7.5) and age < 7 years (HR 1.9; 1.1–3.3), but not for surgical category or other factors. Conclusion: Young age and more extensive cholesteatoma increase the risk of recurrent cholesteatoma in children. When controlling for these factors, surgical approach does not have a significant effect on this outcome. Other objectives, such as lower post-operative morbidity and better hearing outcome, may prove to be more appropriate parameters for selecting optimal surgical approach in children. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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12 pages, 5512 KiB

Open AccessArticle

Hearing Outcome and Predictors after Implanting Bone Conduction or Middle Ear Implants in Ears with Refractory Otitis Media

by Sho Kurihara, Takeshi Nakamura, Kan Kubuki, Hiroyuki Koga, Takashi Goto, Shouken Shimoara, Akira Ganaha, Yuusuke Yamada, Kuniyuki Takahashi and Tetsuya Tono

J. Clin. Med. 2023, 12(12), 4086; https://doi.org/10.3390/jcm12124086 - 16 Jun 2023

Viewed by 1144

Abstract

Bone conduction implants (BCIs) and middle ear implants (MEIs) are promising options for individuals with persistent chronic inflammation of the middle or outer ear. However, the structure of the middle ear is often altered in patients who undergo mastoidectomy or posterior wall removal for refractory otitis media, leaving uncertainty regarding the efficacy of hearing devices. Only a few studies have examined auditory outcomes based on the etiology of hearing impairment. We investigated hearing outcomes, including speech audiometry, in patients who underwent implantation after surgery for refractory otitis media. Our findings indicated that patients who received BCIs or MEIs achieved favorable hearing outcomes. Furthermore, a correlation was observed between the preoperative bone-conduction threshold at 1 kHz in the better ear and the sound-field threshold at 1 kHz with BCIs, whereas no correlation was observed between the preoperative bone-conduction threshold and the sound-field threshold with MEIs. This study highlights the positive impact of BCIs and MEIs in patients who undergo implantation after surgery for refractory otitis media. Additionally, our study identified parameters that predict postoperative efficacy. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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12 pages, 2426 KiB

Open AccessArticle

Effectiveness and Safety of Attic Exposition–Antrum Exclusion versus Canal Wall-Up in Patients with Acquired Stage Ib and II Cholesteatoma Affecting the Attic and Tympanic Cavity

by Francisco Arias Marzán, Esteban Reinaldo Pacheco Coronel, Ayoze Lemes Robayna, Maria Cecilia Salom Lucena, Gemma De Lucas Carmona, María Gabriela Muñoz Cordero, Diego Hernando Macias Rodríguez and Alejandro Jimenez Sosa

J. Clin. Med. 2023, 12(1), 49; https://doi.org/10.3390/jcm12010049 - 21 Dec 2022

Viewed by 2226

Abstract

This study aims to test the effectiveness and safety of exteriorization surgery comprising atticotomy and obliteration of the additus ad antrum, also referred to as attic exposition–antrum exclusion (AE-AE) surgery. This surgery combines otoendoscopy with surgical microscopy for the treatment of acquired pars flaccida cholesteatoma in stages Ib and II (according to the classification of the Japan Otological Society) present in the attic and the tympanic cavity. We reviewed a historical cohort of 65 patients. Of the total, 21 were treated with canal wall-up tympanomastoidectomy (CWU). Patients in whom the AE-AE technique was performed had residual and recurrence rates of 0% and 9.1%, respectively, compared with 28.6% and 9.5%, respectively, for those treated with CWU. In the AE-AE procedure, surgery is performed in one stage compared with the two stages in CWU, to address the risk of residual cholesteatoma. Auditory thresholds were higher in the CWU group compared with the AE-AE group in the pre-surgery (53 ± 16 vs. 44 ± 15 dB; p = 0.039) and post-surgery (52 ± 18 vs. 42 ± 16 dB; p = 0.042) evaluations but not in pre–post-surgery comparisons for either the AE-AE technique (p = 0.89) or the CWU technique (p = 0.96). We conclude that AE-AE is an effective and safe technique for the treatment of acquired stage Ib and II cholesteatoma present in the attic and tympanic cavities. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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11 pages, 1091 KiB

Open AccessArticle

Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study

by Salvatore Ferlito, Gianluca Fadda, Jerome Rene Lechien, Giovanni Cammaroto, Ricardo Bartel, Andrea Borello, Giovanni Cavallo, Francesca Piccinini, Ignazio La Mantia, Salvatore Cocuzza, Federico Merlino, Andrea Achena, Cristina Brucale, Quentin Mat, Stéphane Gargula, Nicolas Fakhry and Antonino Maniaci

J. Clin. Med. 2022, 11(23), 7000; https://doi.org/10.3390/jcm11237000 - 26 Nov 2022

Cited by 11 | Viewed by 2341

Abstract

Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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11 pages, 1898 KiB

Open AccessArticle

The Relationship between the M1/M2 Macrophage Polarization and the Degree of Ossicular Erosion in Human Acquired Cholesteatoma: An Immunohistochemical Study

by Mohamed Bassiouni, Philipp Arens, Samira Ira Zabaneh, Heidi Olze, David Horst and Florian Roßner

J. Clin. Med. 2022, 11(16), 4826; https://doi.org/10.3390/jcm11164826 - 18 Aug 2022

Cited by 4 | Viewed by 4559

Abstract

The differential involvement of the macrophage activation phenotypes (M1 vs. M2) has been linked to disease severity in various chronic inflammatory disorders. Pharmacologic manipulation of the M1/M2 macrophage polarization has shown therapeutic potential. Cholesteatoma is a destructive chronic middle ear disease with potentially life-threatening complications. The distribution of macrophage polarization phenotypes in middle ear cholesteatoma has not been described. In the present study, human cholesteatoma specimens acquired during tympanomastoidectomy were retrospectively retrieved and immunohistochemically characterized using a combination of antibodies labeling M1 macrophages (CD80), M2 macrophages (CD163), and total macrophages (CD68). The correlations between the immunohistochemical findings and clinical presentation were assessed. The findings revealed that cholesteatomas with more extensive ossicular erosion demonstrated a significantly higher number of M1 (CD80+) cells and a higher M1/M2 ratio than less invasive cholesteatomas (Wilcoxon test, p < 0.05). The extent of ossicular erosion correlated significantly with the M1/M2 ratio (Spearman correlation coefficient ρ = 0.4, p < 0.05). Thus, the degree of ossicular erosion in human acquired cholesteatoma appears to be related to the M1/M2 macrophage polarization. The investigation of macrophage polarization and functions in various clinical presentations of middle ear cholesteatoma is of great interest since it may contribute to the development of pharmaceutical treatment approaches. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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11 pages, 2867 KiB

Open AccessArticle

The Relationship between Bone Conduction Hearing Threshold Shifts after Surgery for Chronic Otitis Media with Cholesteatoma According to STAM, EAONO/JOS, and SAMEO-ATO Classifications

by Jan Mejzlik, Viktor Chrobok, Michal Homolac, Tomas Valenta, Anna Svejdova, Michal Cerny, Maja Striteska, Jana Krtickova and Lukas Skoloudik

J. Clin. Med. 2022, 11(15), 4481; https://doi.org/10.3390/jcm11154481 - 1 Aug 2022

Cited by 1 | Viewed by 1727

Abstract

Background: This study focuses on the hearing threshold for bone conduction (BC) after middle-ear surgery. Methods: A total of 92 patients (120 ears) were treated for newly diagnosed chronic otitis media with cholesteatoma (2013–2018). BC was examined at frequencies of 0.5, 1, 2, and 4 kHz prior to and 1 year after surgery. STAM classification for cholesteatoma location, EAONO/JOS for stage, and surgery according to SAMEO-ATO classification were applied. The bone conduction threshold was compared for individual frequencies in patients with occurrence/absence of cholesteatoma in different locations. Results: For the occurrence of cholesteatoma in the attic (A), a statistically significant difference was found at 4 kHz (p < 0.001), in the supratubal recess (S1) at 4 kHz (p = 0.003), and for the mastoid (M) at 0.5 kHz (p = 0.024), at 1 kHz (p = 0.032), and at 2 kHz (p = 0.039). Conclusions: Cholesteatoma location can influence the post-operative hearing threshold for bone conduction. Full article

(This article belongs to the Special Issue Recent Advances in Otitis Media and Cholesteatoma)

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