Email this article Management and surgical outcomes in patients with chronic suppurative otitis media
- Authors: Daikhes N.A.1, Diab K.M.1, Korvyakov V.S.1, Kondratchikov D.S.1, Pashchinina O.A.1, Umarov P.U.1, Mikhalevich А.E.1, Medeulova A.R.1
-
Affiliations:
- Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
- Issue: Vol 44, No 7 (2016)
- Pages: 814-820
- Section: ARTICLES
- URL: https://almclinmed.ru/jour/article/view/389
- DOI: https://doi.org/10.18786/2072-0505-2016-44-7-814-820
- ID: 389
Cite item
Full Text
Abstract
Background: Reconstruction of the ossicular chain is performed in 70-90% of tympanoplastic interventions. A cholesteatoma in chronic suppurative otitis media is diagnosed in 24-63% cases, irrespective of localization of the eardrum perforation. Persistently good outcomes after radical mastoidectomy is obtained only in 65 to 66% of patients, and the proportion of unsatisfactory results remains to be rather high (10 to 15%). Aim: To analyze the effectiveness of surgical treatment of patients with chronic suppurative otitis media, operated in a single clinical center from 2014 to 2016. Materials and methods: A total of 212 patients (233 ears) with chronic suppurative otitis media patients, who underwent surgery, were included in this study. The effectiveness of surgical interventions were assessed as short-term (up to 3 months post-operatively) and long-term (6 to 12 months) anatomical and functional outcomes. The anatomical results were considered satisfactory if there was a well-formed mobile neotympanic membrane, air tympanic cavity and dry postoperative cavity. Pure tone audiograms were analyzed to evaluate the functional results. Results: Satisfactory anatomical results were obtained in 93.5% of patients with the safe type suppurative otitis, 88.9% of patients with the unsafe type and 91.2% of patients after a revision surgery. Displacement of total ossicular prosthe-ses was the main cause of poor functional results. The most common causes of unsatisfactory anatomical results were perforation (14 cases), cholesteatoma recurrence (2 cases) and lateralization of the neotympanic membrane (2 cases). Discussion and conclusion: Formation of a reliable sound conducting system with ossicular prostheses allows for persistent improvement of hearing. Various surgical techniques, such as extended posterior tympanotomy, endoscopic assistance, provide a good effect with the removal of non-aggressive cholesteatoma while preserving the bone structures, which are not involved in the disease. A complete removal of an advanced aggressive cholesteatoma with the opening of the temporal bone cell system ensures good functional and anatomical outcomes, makes it possible to prevent the spread of the pathological process and development of intracranial complications.
About the authors
N. A. Daikhes
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Daikhes Nikolay A. - MD, PhD, Professor, Director
РоссияKh. M. Diab
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Author for correspondence.
Email: hasandiab@mail.ru
Diab Khassan Mokhamad Ali - MD, PhD, Chief Research Fellow, Department of Ear's Diseases.
30/2 Volokolamskoe shosse, Moscow, 123182, Russian Federation. Tel.: +7 (919) 101 33 00. E-mail: hasandiab@mail.ru
РоссияV. S. Korvyakov
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Korvyakov Vasiliy S. - MD, PhD, Chief Research Fellow, Department of Ear's Diseases
РоссияD. S. Kondratchikov
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Kondratchikov Dmitriy S. - MD, Junior Research Fellow, Department of Ear's Diseases
РоссияO. A. Pashchinina
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Pashchinina Ol’ga A. - MD, PhD, Senior Research Fellow, Department of Ear's Diseases
РоссияP. U. Umarov
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Umarov Parviz U. - MD, PhD, Research Fellow, Department of Ear's Diseases
РоссияА. E. Mikhalevich
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Mikhalevich Anton E. - Intramural Postgraduate Student, Department of Ear's Diseases
РоссияA. R. Medeulova
Otorhinolaryngology Clinical Research Center of the Federal Medico-Biological Agency, Moscow
Email: fake@neicon.ru
Medeulova Aygul R. - Extramural Postgraduate Student, Department of Ear's Diseases Россия
References
- Brackmann DE, Shelton C, Arriaga MA. Otologic surgery. 3rd edition. Philadelphia: Saunders Elsevier; 2010. 831 p.
- Chole RA. Ossiculoplasty with presculpted banked cartilage. Otolaryngol Clin North Am. 1994;27(4):717-26.
- Felek SA, Celik H, Islam A, Elhan AH, Demirci M, Samim E. Type 2 ossiculoplasty: prognostic determination of hearing results by middle ear risk index. Am J Otolaryngol. 2010;31(5):325-31. doi: 10.1016/j.amjoto.2009.03.006.
- Аникин ИА, Диаб ХМ, Астащенко СВ, Карапетян РВ, Мустивый ИФ. Реконструктивная слухоулучшающая операция с различными вариантами оссикулопластики у больных, перенесших консервативно-щадящие радикальные операции на среднем ухе. Российская оториноларингология. 2012;3(58):10—6.
- Kim JH, Choi SH, Chung JW. Clinical results of atticoantrotomy with attic reconstruction or attic obliteration for patients with an attic cholesteatoma. Clin Exp Otorhi-nolaryngol. 2009;2(1):39-43. doi: 10.3342/ceo.2009.2.1.39.
- Карапетян РВ, Аникин ИА, Астащенко СВ, Аникин МИ, Бокучава ТА. Хирургическое лечение хронического гнойного эпиантраль-ного отита с холестеатомой. Российская оториноларингология. 2013;(4):29-35.
- Berlin S, Kutluhan A, Bozdemir K, Yalgner G, Sari N, Karamese O. Results of revision mastoidectomy. Acta Otolaryngol. 2009;129(2):138-41. doi: 10.1080/00016480802140893.
- Ахмедов ШМ, Корвяков ВС, Мухамедов ИТ, Кочарян ЕЗ, Лекишвили МВ, Жидков ИЛ, Зелянин АС, Ситниченко НВ, Миха-левич АЕ. Одномоментная реконструкция задней стенки наружного слухового прохода и кортикального слоя сосцевидного отростка при хирургическом лечении больных эпимезои эпитимпанитом. Российская оториноларингология. 2014;(5):9-15.
- Неъматов ЖС, Аникин ИА, Комаров МВ, Му-стивый ИФ, Полшкова ЛВ, Астащенко СВ. Причины неэффективности тимпанопласти-ки по закрытому типу. Российская оториноларингология. 2012;(2):111-7.
- Faramarzi A, Motasaddi-Zarandy M, Khor-sandi MT. Intraoperative findings in revision chronic otitis media surgery. Arch Iran Med. 2008;11(2):196-9. doi: 08112/AIM.0013.
- Kaylie DM, Gardner EK, Jackson CG. Revision chronic ear surgery. Otolaryngol Head NeckSurg. 2006;134(3):443-50. doi: 10.1016/j.otohns.2005.10.044.
- Magliulo G, D'Amico R, Fusconi M. Reconstruction of old radical cavities and long-term results. J Otolaryngol. 2004;33(3):155-9.
- Edelstein DR, Kraus DH, Pastorek NJ, Sele-snick SH, Ward RF, editors. Revision surgery in otolaryngology. New York: Theme Medical Publishers; 2009. 481 p.
- Alves AL, Pereira CS, Carvalho Mde F, Freg-nani JH, Ribeiro FQ. EGFR expression in acquired middle ear cholesteatoma in children and adults. Eur J Pediatr. 2012;171(2):307-10. doi: 10.1007/s00431-011-1526-2.
- Juhasz A, Sziklai I, Rakosy Z, Ecsedi S, Adany R, Balazs M. Elevated level of tenascin and matrix metalloproteinase 9 correlates with the bone destruction capacity of cholesteatomas. Otol Neurotol. 2009;30(4):559-65. doi: 10.1097/MAO.0b013e31819fe6ed.
- Ахмедов ШМ. Метод тимпанопластики у больных мезотимпанитом. Российская оториноларингология. 2014;(3):6-11.
- Крюков АИ, Гаров ЕВ, Антонян РГ, Азаров ПВ, Гутиева ТХ. Раздельная аттикоантротомия с тимпанопластикой I типа как операция выбора при хроническом перфоративном среднем отите с выраженным мукозитом. Вестник оториноларингологии. 2011;(5):32-4.
- Atila NE, Kilic K, Sakat MS, Altas E, Ucuncu H, Bulut YE. Stabilization of total ossicular replacement prosthesis using cartilage "shoe" graft. Am J Otolaryngol. 2016;37(2):74-7. doi: 10.1016/j.amjoto.2015.12.001.
- Lee DW, Chung JH, Lee SH, Park CW, Kang SH, Oh YH, Pyo JY. Comparative analysis of the expression of E-cadherin, p-catenin, and P1 integrin in congenital and acquired cholesteatoma. Eur Arch Otorhinolaryngol. 2016;273(4):845-51. doi: 10.1007/s00405-015-3621-x.
- Dornelles C, Meurer L, Selaimen da Costa S, Schweiger C. Histologic description of acquired cholesteatomas: comparison between children and adults. Braz J Otorhinolaryngol. 2006;72(5):641-8. Available from: http://dx. doi.org/10.1590/S0034-72992006000500010.
- Deniz M, Uslu C, Koldaj C, Deniz B. Which technique is better for cholesteatoma surgery? B-ENT. 2015;11(2):109-15.
- Hanson JR, Esquivel C, Backous DD. Diagnosis and management of aggressive, acquired cholesteatoma with skull base and calvarial involvement: a report of 3 cases. Am J Otolaryngol. 2006;27(4):291-4. doi: 10.1016/j.amjo-to.2005.11.010.
Supplementary files
