Objective:To investigate the occurrence and managements of poor recovery after total endoscopic middle ear surgery. Methods:A total of 302 cases（315 ears） who underwent endoscopic middle ear surgery in our hospital from June 2020 to June 2021 were collected. Follow up by means of endoscopy, pure tone hearing threshold, tympanogram was conducted at 1 month, 3 months, 6 months and 1 year after surgery to analyze the incidence, possible causes, treatment strategies and effects of poor results tympanic membrane healing and hearing recovery. Results:Among 302 patients（315 ears） followed up, there were 28 cases with poor recovery. There were fourteen cases of poor eardrum healing, of which 10 cases achieved healing of eardrum after tympanic membrane patching in the outpatient department, with a success rate of about 71.4%. TM recurrence adhesion occurred in 4 cases after surgeries of cholesteatoma and adhesive otitis media. One case completely recovered after self eustachian tube insufflation, while 2 cases maintained the degree of eardrum subsidence, and one ineffective patient chose resurgical treatment, with an effective rate was 75.0%. Failure in hearing improvement occurred in 8 cases, all of which underwent second surgical exploration, and seven cases were improved after the second surgery, with an effective rate of 87.5%. Among the 8 patients with no improvement or aggravation of hearing loss after surgery, four cases had postoperative B-type or C-type of tympanogram, and the hearing could not improve after self eustachian tube insufflation for secondary surgical exploration. and the hearing improved after the secondary surgery. Incorrect orientation of ossicular prosthesis was accounted for another 2 cases, the hearing was improved after the ossicular orientation adjustment. One patient with lateral healing of TM and failed hearing recovery was corrected by a second operation. One case of tympanosclerosis underwent stapes release surgery, but hearing recovery still failed. One patient had recurrent postoperative cicatricial atresia of external auditory canal, and the patient was reluctant to undergo reoperation. Postoperative delayed facial paralysis occurred in 1 case, and the facial paralysis recovered recovered after conservative treatments. Conclusion:Eardrum patch and eustachian tube autoflation are simple and effective early outpatient treatment for patient with poor recovery. For those who failed with conservative treatments such as eardrum patch or eustachian tube and poor hearing recovery, the second surgical exploration is safe and effective. Regular follow up after endoscopic middle ear surgery is necessary for the managements of poor recovery.
Humans ; Ear, Middle/surgery* ; Female ; Male ; Endoscopy/methods* ; Adult ; Middle Aged ; Tympanic Membrane/surgery* ; Treatment Outcome ; Hearing Loss/surgery* ; Otologic Surgical Procedures/methods* ; Otitis Media/surgery* ; Eustachian Tube/surgery*

Objective:To describe a novel approach for intractable Meniere's disease exclusively through a transcanal endoscopic ear surgery（TEES）. Methods:This retrospective chart review included patients with intractable Menière's disease who underwent endoscopic transcanal labyrinthectomy in the Department of Otolaryngology Head and Neck Surgery, Guangxi Hospital Division, First Affiliated Hospital, Sun Yat-sen University, between February 2023 and October 2024. The first 70-year-old woman and the other 67-year-old woman, who underwent multiple conservative treatment and chemical labyrinthectomy during outpatient and hospitalization, had frequent vertigo, tinnitus and severe sensorineural deafness. The TEES approach provided a wide exposure of the oval window. The incus and the stapes were removed, expanded the oval window. The perilymph was suctioned, The saccule, utricule, macula utriculi and macula sacculi were removed. The ampulla tissue of the three semicircular canal were destroyed with the right-angle crochet. The oval window was obliterated using the perichondrium of the tragal cartilage and cartilage. Results:Two patients underwent endoscopic transcanal labyrinthectomy, and no intraoperative or postoperative complications were observed. Vertigo was controlled in 2 patients during the follow-up of 6 to 12 months. Two patients complained of total hearing loss after surgery. Conclusion:Even though this study presents a limited number of cases, endoscopic transcanal labyrinthectomy is a promising, safe, and effective procedure in selected cases. Additional studies are needed to determine the risk-benefit profile of this technique.
Humans ; Aged ; Female ; Meniere Disease/surgery* ; Retrospective Studies ; Endoscopy/methods* ; Otologic Surgical Procedures/methods* ; Ear, Inner/surgery* ; Treatment Outcome

Objective: To introduce a new self-developed irrigation device(SID) that does not employ a sheath or an irrigation-suction system and evaluate to its efficiency in transcanal endoscopic ear surgery (TEES) for attic cholesteatoma. Methods: 38 patients who were subjected to TEES for attic cholesteatoma between October 2019 to June 2021 were included in this study, including 17 males and 21 females with an average age of (38.6±11.9) years. SID and underwater continuous drilling were used during operation. Width of endoscope and irrigation speed were measured when SID was applied. The operating time, surgical view and complications were compared between two groups. Results: The width of the endoscope was 3.5-4.6 mm in diameter and the irrigation speed was 20-40 ml/min when SID was used. SID cleaned the lens at the tip of the endoscope and created a clear field of view during TEES. The operation time was (86.6±18.1) min. The skin of the external ear canal was found injured during operation in 3 patients, but there were no complications such as necrosis of the flap, stenosis of external ear canal, sensorineural hearing loss, facial paralysis and cerebrospinal fluid leakage. Conclusions: SID is simple and enhances the efficacy of TEES, providing a new irrigation choice in TEES for attic cholesteatoma.
Humans ; Male ; Female ; Adult ; Middle Aged ; Cholesteatoma, Middle Ear/surgery* ; Suction ; Sudden Infant Death ; Otologic Surgical Procedures ; Ear, Middle/surgery*

Objective: To determine the relationship of the surgeon handedness and operative site laterality on operative duration and hearing improvement in otologic surgery, and to further explore whether this relationship may be related to surgeon experience. Methods: Design: Retrospective Cohort Setting: Tertiary Private Teaching Hospital Participants: Seventy-three (73) patients aged 18 to 65 years old who underwent primary ear surgery under general anesthesia between January 2016 and December 2019 were retrospectively divided into two groups: 39 contralateral and 34 ipsilateral. The operative durations and hearing improvements were compared using independent t-tests, with consideration of surgeon experience in years further stratifying patients. Results: There was no significant difference in operative duration, t(71) = 1.14, p = .26, between the contralateral (M = 281.95 minutes, SD = 71.82) and ipsilateral (M = 261.15, SD = 79.26) groups. This same pattern was more pronounced among surgeons with 10+ years of experience although there was also no significant difference in operative time, t(33) = 1.31, p = .19 for both ipsilateral and contralateral surgeries There was no statistically significant difference, t(36) = -0.72, p = .47, in overall mean hearing gain among patients in the contralateral (M = +2.22 dB, SD = 10.54) and ipsilateral (M = +5.12 dB, SD = 14.26) groups. Although the difference was also not statistically significant, t(16) = -1.94, p = .07 for contralateral (M = 0.00, SD = 5.43) and ipsilateral (M = +7.95 dB, SD = 11.52) procedures performed by surgeons with experience of 10 years or more, a mean hearing gain of +7 dB in the ipsilateral group compared to 0 dB in the contralateral group was notable. Conclusion: This study did not prove that regardless of surgeon experience, right-handed surgeons operating on the right ear and left-handed surgeons operating on the left ear have better ear surgery outcomes of operative duration and hearing improvement compared to right- handed surgeons operating on the left ear and left-handed surgeons operating on the right ear. Future studies on larger samples with more complete data may yet demonstrate this effect.
Functional Laterality ; otologic surgical procedures ; hearing ; operative time

BACKGROUND AND OBJECTIVES: This study aims to evaluate that usefulness of the endoscopic ear surgery (EES) through the systematic review. SUBJECTS AND METHOD: We searched literatures in literature databases (MEDLINE, EMBASE, Cochrane Library, etc.). Inclusion criteria is 1) studies of patients with chronic otitis media, otitis media with effusion, cholesteatoma, conductive hearing loss, mixed hearing loss etc. 2) studies in which a transcanal endoscopic surgery was performed; and 3) studies in which one or more of the appropriate medical outcomes have been reported. We excluded that 1) non-human studies and pre-clinical studies; 2) non-original articles, for example, non-systematic reviews; editorial, letter and opinion pieces; 3) research not published in Korean and English; and 4) grey literature. Finally, 65 articles were selected and those results were analyzed. RESULTS: The safety of the EES was reported in 61 articles. Some studies reported damaged facial nerve or perilymph gusher but these are the complications that can arise due to the characteristics of the disease and not due to the EES and other reported complications were of similar or lower level in the intervention group rather than the microscopy group. The effectiveness of the EES was reported in 23 articles. The EES tended to show improved effects in terms of graft uptake status, cholesteatoma removal, and hearing improvement although effective outcomes of most studies reported no significant difference between EES and microscopic ear surgery. CONCLUSION: EES is a safe and effective technique and as it is less invasive than the microscopic ear surgery.
Cholesteatoma ; Ear ; Endoscopes ; Facial Nerve ; Hearing ; Hearing Loss, Conductive ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Methods ; Microscopy ; Otitis Media ; Otitis Media with Effusion ; Otologic Surgical Procedures ; Perilymph ; Transplants

BACKGROUND AND OBJECTIVES: This study aimed 1) to compare the rates of surgical site infection (SSI) between two groups with and without preoperative hair shaving, 2) to compare the bacterial colonization just before the skin incision between them, and 3) to evaluate people’s preference for the hair shaving. SUBJECTS AND METHODS: The retrospective study enrolled cases in which middle ear and mastoid surgery was performed with as well as without hair removal. Main measurement outcomes were the SSI rate within 3 months following the surgery, bacterial culture results obtained from the incision area just before the skin incision, and questionnaire to evaluate the preference for hair shaving from patients with chronic suppurative otitis media but without experience with the ear surgery. RESULTS: This study did not show any difference in the rates of SSI and bacterial colonization between two groups with and without preoperative hair shaving. Most patients without experience with the ear surgery chose the nonshaved ear surgery, even though the questionnaire presented a comment as follow; “Your hair will always grow back as the growth speed of about 1.25 cm per month.” CONCLUSIONS: There is no evidence showing that preoperative shaving of the surgical site is helpful for the SSI than no hair removal. Nonshaved middle ear and mastoid surgery via postauricular approach appears to be preferable. Contrary to doctors’ popular belief, the hair shaving can cause psychological discomfort, especially for women. Now is the time to keep the balance between the professional’s perspective and the patients’ preferences.
Colon ; Ear ; Ear, Middle ; Female ; Hair Removal ; Hair ; Humans ; Mastoid ; Otitis Media, Suppurative ; Otologic Surgical Procedures ; Preoperative Care ; Retrospective Studies ; Skin ; Surgical Wound Infection

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.
Adhesives ; Cholesteatoma ; Diagnosis ; Ear, Middle* ; Humans ; Mastoid* ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Temporal Bone* ; Tympanic Membrane

BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate postoperative mastoid aeration according to the preoperative middle ear disease and investigate the factors affecting it. SUBJECTS AND METHODS: We retrospectively reviewed the high-resolution computed tomography (CT) scans of temporal bones that were taken 1 year after surgery. The postoperative mastoid aeration was evaluated according to the preoperative diagnosis, and classified into three groups: grade 1 (complete mastoid aeration), an air-filled epitympanum and mastoid cavity; grade 2 (partial mastoid aeration), an air-filled epitympanum and partially aerated mastoid cavity; and grade 3 (absence of mastoid aeration), no air space in the mastoid cavity. RESULTS: The overall mastoid aeration rate was 55.8%, with adhesive otitis media accounting for 21.2%, attic cholesteatoma 53.8%, and chronic otitis media 75.4%. The rates of postoperative mastoid aeration were significantly higher in the chronic otitis media cases and attic cholesteatoma cases than in the adhesive otitis media cases. There were 14 cases requiring revision operations due to the development of a retraction pocket in the tympanic membrane. All of the revised cases had grade 3 postoperative mastoid aeration, and underwent canal wall down mastoidectomies. CONCLUSIONS: The degree of postoperative mastoid aeration is associated with the preoperative middle ear disease. When planning a canal wall up mastoidectomy, the surgeon should contemplate the middle ear disease, because a canal wall down mastoidectomy or mastoid obliteration is recommended if the patient has adhesive otitis media.
Adhesives ; Cholesteatoma ; Diagnosis ; Ear, Middle* ; Humans ; Mastoid* ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Temporal Bone* ; Tympanic Membrane

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.
Audiometry ; Cholesteatoma* ; Hearing ; Humans ; Mastoid ; Methods ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Tympanoplasty*

BACKGROUND: In the surgical correction of prominent ear, a technique known as percutaneous adjustable closed otoplasty (PACO), which does not involve skin incision, undermining, or cartilage manipulation, has been developed to resolve problems including hematoma, infection, contour deformities, prolonged use of a compressive dressing, and hospitalization. We modified this procedure to make it more practical and accessible and to achieve better results. In this article, we introduce our modifications and demonstrate the clinical applicability of the modified procedure to patients with hardened auricular cartilage. METHODS: Two adult patients with prominent upper ears underwent closed otoplasty in an outpatient setting. Based on the anatomical features of the patients, three lines for traction sutures were designed on the scapha and counter scapha. Tab incisions were made at all predetermined puncture sites. Three antihelix-forming sutures (4-0 nylon) were put in place via percutaneous punctures. The sutures were performed from the counter scapha to the postauricular sulcus subcutaneously, using an 18-mm empty curved needle. The sutures were scraped over the mastoid bone such that they were anchored to the mastoid periosteum. After determining an adequate auriculocephalic distance, the sutures were tied at the postauricular sulcus. A slight overcorrection was made to compensate for post-surgical relapse. RESULTS: We observed no complications such as hematoma, infection, contour deformities, epithelial inclusion cyst formation, suture extrusion, or dimples on the scapha. At a long-term follow-up examination, the patients had well-defined antihelical folds and were satisfied with the aesthetic results of the procedure. CONCLUSIONS: We propose our technique as a reliable treatment option for the correction of prominent ear.
Adult ; Bandages ; Cartilage ; Congenital Abnormalities ; Ear Auricle ; Ear Cartilage ; Ear* ; Follow-Up Studies ; Hematoma ; Hospitalization ; Humans ; Mastoid ; Needles ; Otologic Surgical Procedures ; Outpatients ; Periosteum ; Punctures ; Recurrence ; Skin ; Sutures ; Traction