المؤلفون: Toloczko, Alexandra J.¹ (AUTHOR), Davis, Thomas S.² (AUTHOR), Issa, Mayada H.² (AUTHOR) mhissa@carilionclinic.org

المصدر: Journal of Medical Case Reports. 7/12/2024, Vol. 18 Issue 1, p1-5. 5p.

مصطلحات موضوعية: *CHOLESTEATOMA, *ABSCESSES, *EAR infections, *OTITIS media, *MIDDLE ear, *MASTOIDITIS

مستخلص: Background: Mastoiditis frequently occurs in children as they are more susceptible to middle ear infections, but infrequently occurs in adults. A rare complication that results from mastoiditis and an obstructing cholesteatoma is a Bezold's abscess, of which there are less than 100 reported cases in literature to date. Case presentation: Here, we present a case of a 72-year-old Caucasian man who has had no history of prior ear infections and was found to have a cholesteatoma and advanced acute coalescent mastoiditis complicated by a Bezold's abscess. Conclusions: Bezold's abscess is a rare entity infrequently encountered in the modern era, likely owing to more prompt treatment of otitis media. Cholesteatoma poses a great risk for both the development of otitis media and further progression to mastoiditis and its associated complications, such as Bezold's abscess. Knowledge of said abscess is crucial; without prompt recognition, further spread of infection can occur with vascular or mediastinal involvement. [ABSTRACT FROM AUTHOR]

المؤلفون: Xie, Mengyao¹ (AUTHOR), Tang, Qi¹ (AUTHOR), Wang, Shu¹ (AUTHOR), Huang, Xiaowu² (AUTHOR), Wu, Zhiyuan^1,3 (AUTHOR), Han, Zhijin¹ (AUTHOR), Li, Chen¹ (AUTHOR), Wang, Bin¹ (AUTHOR), Shang, Yingying¹ (AUTHOR), Yang, Hua¹ (AUTHOR) dr_yanghua2021@163.com

المصدر: BMC Medical Genomics. 6/18/2024, Vol. 17 Issue 1, p1-10. 10p.

مصطلحات موضوعية: *GENE expression, *CHOLESTEATOMA, *MIDDLE ear, *RNA sequencing, *NON-coding RNA, *GENE ontology

مستخلص: Background: The present study aims to identify the differential miRNA expression profile in middle ear cholesteatoma and explore their potential roles in its pathogenesis. Methods: Cholesteatoma and matched normal retroauricular skin tissue samples were collected from patients diagnosed with acquired middle ear cholesteatoma. The miRNA expression profiling was performed using small RNA sequencing, which further validated by quantitative real-time PCR (qRT-PCR). Target genes of differentially expressed miRNAs in cholesteatoma were predicted. The interaction network of 5 most significantly differentially expressed miRNAs was visualized using Cytoscape. Further Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genome (KEGG) pathway enrichment analyses were processed to investigate the biological functions of miRNAs in cholesteatoma. Results: The miRNA expression profile revealed 121 significantly differentially expressed miRNAs in cholesteatoma compared to normal skin tissues, with 56 upregulated and 65 downregulated. GO and KEGG pathway enrichment analyses suggested their significant roles in the pathogenesis of cholesteatoma. The interaction network of the the 2 most upregulated (hsa-miR-21-5p and hsa-miR-142-5p) and 3 most downregulated (hsa-miR-508-3p, hsa-miR-509-3p and hsa-miR-211-5p) miRNAs identified TGFBR2, MBNL1, and NFAT5 as potential key target genes in middle ear cholesteatoma. Conclusions: This study provides a comprehensive miRNA expression profile in middle ear cholesteatoma, which may aid in identifying therapeutic targets for its management. [ABSTRACT FROM AUTHOR]

المؤلفون: Mei, Honglin^1,2 (AUTHOR), Lu, Xiaoling^1,2 (AUTHOR), Dong, Chunguang³ (AUTHOR), Lin, Hailiang^1,2 (AUTHOR), Chen, Bing^1,2,4 (AUTHOR) bingchen@fudan.edu.cn, Li, Huawei^1,2,4,5 (AUTHOR) hwli@shmu.edu.cn, Ni, Yusu^1,2,6 (AUTHOR) niyusu@aliyun.com

المصدر: European Archives of Oto-Rhino-Laryngology. Jun2024, Vol. 281 Issue 6, p2905-2912. 8p.

مصطلحات موضوعية: *FACIAL nerve, *CHOLESTEATOMA, *FACIAL paralysis, *MEDICAL records, *OPERATIVE surgery, *PAROTIDECTOMY, *MASTOIDECTOMY

مستخلص: Purpose: The narrow supralabyrinthine space affects surgical procedures. To study the effect of temporary transposition of geniculate ganglion of facial nerve versus nontransposition on lesion recurrence and facial nerve function in patients with petrous bone cholesteatoma. Methods: A total of 18 patients with petrous bone cholesteatoma involving the facial nerve were treated in our hospital from November 2016 to March 2023. The main surgical method is the extended supralabyrinthine approach assisted by a microscope and an endoscope. We collected and retrospectively analyzed their medical records. Results: Temporary facial nerve transposition was performed in five patients, and nontransposition was performed in 13 patients. Cholesteatoma recurred in three patients with facial nerve nontransposition, whereas none in patients with facial nerve transposition. In this study, except for one case with a second operation, postoperative facial paralysis in other cases was improved to varying degrees, and there was no significant difference between the two groups. Conclusion: Temporary transposition of geniculate ganglion of facial nerve will not affect the postoperative nerve function of patients and can reduce the possibility of cholesteatoma recurrence of the petrous bone. [ABSTRACT FROM AUTHOR]

المؤلفون: Esu, Yoshihiko¹ (AUTHOR) yesu@jichi.ac.jp, Tamii, Satoru¹ (AUTHOR), Kanazawa, Hiromi¹ (AUTHOR), Iino, Yukiko² (AUTHOR), Yoshida, Naohiro¹ (AUTHOR)

المصدر: Auris Nasus Larynx. Jun2024, Vol. 51 Issue 3, p465-471. 7p.

مصطلحات موضوعية: *CHOLESTEATOMA, *MYRINGOPLASTY, *MASTOIDECTOMY, *TYMPANIC membrane perforation, *SENSORINEURAL hearing loss, *MIDDLE ear, *OPERATIVE surgery

مستخلص: Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing. This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25). The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss. Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution. [ABSTRACT FROM AUTHOR]

المؤلفون: Yamada, Yusuke^1,2 (AUTHOR) takashi_goto@med.miyazaki-u.ac.jp, Ganaha, Akira^2,3 (AUTHOR) ganaha.akira.t8@iuhw.ac.jp, Nojiri, Nao^1,2 (AUTHOR) nao-nojiri@iuhw.ac.jp, Goto, Takashi² (AUTHOR), Takahashi, Kuniyuki² (AUTHOR), Tono, Tetsuya^1,2 (AUTHOR) tono@med.miyazaki-u.ac.jp

المصدر: Journal of Clinical Medicine. May2024, Vol. 13 Issue 10, p2934. 10p.

مصطلحات موضوعية: *MASTOIDECTOMY, *CHOLESTEATOMA, *TEMPORAL bone, *MIDDLE ear, *BONE growth, *COMPUTED tomography

مستخلص: 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. [ABSTRACT FROM AUTHOR]

المؤلفون: Alshehri, Sarah¹ (AUTHOR) saaalshehri@kku.edu.sa, Al Shalwan, Mohammed Abdullah M.² (AUTHOR) 438802269@kku.edu.sa, Oraydan, Abdulkhaliq Abdullah A.² (AUTHOR) 438802257@kku.edu.sa, Almuaddi, Abdulrahman Saeed H.² (AUTHOR) 438802270@kku.edu.sa, Alghanim, Ahmed Jubran A.² (AUTHOR) 438802278@kku.edu.sa

المصدر: Journal of Clinical Medicine. May2024, Vol. 13 Issue 9, p2606. 14p.

مصطلحات موضوعية: *CHOLESTEATOMA, *CROSS-sectional method, *DEMOGRAPHIC characteristics, *TREATMENT effectiveness, *ENDOSCOPIC surgery, *LOGISTIC regression analysis, *UNIVERSITY hospitals, *MASTOIDECTOMY

مستخلص: Background/Objectives: Cholesteatoma presents significant management challenges in otolaryngology. This study aimed to delineate the influence of demographic and clinical characteristics, preoperative imaging, and surgical approaches on treatment success in cholesteatoma management. Methods: A cross-sectional analytical study was conducted at the Otolaryngology Department of the University Hospital from January 2021 to December 2022. It included 68 patients diagnosed with cholesteatoma, focusing on three objectives: assessing the impact of demographic and clinical characteristics on treatment outcomes, evaluating the predictive value of preoperative imaging findings, and analyzing the influence of surgical factors. Results: The study population predominantly consisted of male (56%) and Saudi (81%) patients, with an average age of 45 years. Logistic regression revealed that older age (OR: 1.05), male gender (OR: 0.63), and non-Saudi Arab ethnicity (OR: 2.14) significantly impacted treatment outcomes. Clinical characteristics such as severe disease severity (OR: 3.00) and longer symptom duration (OR: 0.96) also influenced treatment success. In preoperative imaging, labyrinthine fistula (Regression Coefficient: 0.63) and epidural extension (Coefficient: 0.55) emerged as key predictors. The surgical factors that significantly affected the outcomes included the extent of surgery (Complete Removal OR: 3.32) and the use of endoscopic approaches (OR: 1.42). Conclusions: This study highlights that patient demographics, clinical profiles, specific preoperative imaging features, and surgical strategies multifactorially determine cholesteatoma treatment success. These findings suggest the necessity for a tailored approach in cholesteatoma management, reinforcing the importance of individualized treatment plans based on comprehensive preoperative assessments. [ABSTRACT FROM AUTHOR]

المؤلفون: Díaz Zufiaurre, Natalia¹ (AUTHOR) ndiazzu@unav.es, Calvo-Imirizaldu, Marta² (AUTHOR) mcalvoi@unav.es, Lorente-Piera, Joan¹ (AUTHOR) jlorentep@unav.es, Domínguez-Echávarri, Pablo² (AUTHOR) pdaniel@unav.es, Fontova Porta, Pau³ (AUTHOR) pfontova@alumni.unav.es, Manrique, Manuel¹ (AUTHOR) rmanrique@unav.es, Manrique-Huarte, Raquel¹ (AUTHOR)

المصدر: Journal of Clinical Medicine. May2024, Vol. 13 Issue 9, p2587. 11p.

مصطلحات موضوعية: *CHOLESTEATOMA, *DIFFUSION magnetic resonance imaging, *RECIDIVISM, *MAGNETIC resonance imaging, *REOPERATION, *RECIDIVISM rates, *MASTOIDECTOMY

مستخلص: Background: Cholesteatoma is a lesion capable of destroying surrounding tissues, which may result in significant complications. Surgical resection is the only effective treatment; however, the presence of cholesteatoma recidivism is common. This study evaluated the effectiveness of the Attic Exposure-Antrum Exclusion (AE-AE) surgical technique in treating cholesteatomas and identifying factors associated with recidivism. Additionally, the study aimed to assess the utility of non-echo-planar diffusion MRI (non-EPI-DWI MRI) in detecting cholesteatoma recidivism in patients undergoing AE-AE surgery. Methods: The study involved 63 patients who underwent AE-AE surgery for primary acquired cholesteatoma and were followed up clinically and radiologically for at least five years. The radiological follow-up included a non-EPI-DWI MRI. Results: Results showed that the AE-AE technique successfully treated cholesteatomas, with a recidivism rate of 5.2%. The study also found that non-EPI-DWI MRI was a useful diagnostic tool for detecting cholesteatoma recidivism, although false positives could occur due to the technique's high sensitivity. As Preoperative Pure-tone average (PTA) increases, there is a higher probability of cholesteatoma recidivism in imaging tests (p = 0.003). Conclusions: Overall, the study highlights the importance of the AE-AE surgical technique and non-EPI-DWI MRI in managing cholesteatoma recidivism in patients, providing valuable insights into associated risk factors and how to manage recidivism. Non-EPI-DWI MRI can assist in patient selection for revision surgery, reducing unnecessary interventions and associated risks while improving treatment outcomes and patient care. [ABSTRACT FROM AUTHOR]

المؤلفون: A., Shreelatha¹, Madappanavar, Anand², Krishna, Vindya³, L., Vasanth kumar⁴

المصدر: Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research). 2024, Vol. 15 Issue 4, p304-312. 9p.

مصطلحات موضوعية: *CHOLESTEATOMA, *DIFFUSION magnetic resonance imaging, *MASTOIDECTOMY, *REOPERATION, *TEMPORAL bone, *GRANULATION tissue

مستخلص: Objective To evaluate the diagnostic performance of Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) in the detection of cholesteatoma and assess its potential to replace second-look surgery. Methods: This prospective observational study recruited 65 patients with suspected cholesteatoma and compared DWI-MRI findings with histopathological examination (considered the gold standard). HRCT temporal bone scans were also performed for comparison. Results: DWI-MRI demonstrated high sensitivity (94.23%) and specificity (100%) for cholesteatoma detection. • DWI-MRI outperformed HRCT in both primary (93.8% vs. 87.5%) and recurrent/residual cholesteatoma cases (80% vs. 25.0%). • Mean ADC values were significantly lower in cholesteatoma compared to granulation tissue and inflammatory tissue. Discussion DWI-MRI emerged as a valuable tool for cholesteatoma diagnosis due to its high sensitivity, specificity, and tissue characterization capabilities. It offers a non-invasive alternative to second-look surgery, potentially reducing healthcare costs and complications. Limitations • Smaller lesions may be missed with DWI-MRI. • MRI is expensive and time-consuming compared to HRCT. Conclusion DWI-MRI is a reliable and accurate method for diagnosing cholesteatoma, potentially eliminating the need for second-look surgery in many cases. Future research can explore optimal DWI protocols for smaller lesion detection and establish specific ADC cut-off values for definitive diagnosis. [ABSTRACT FROM AUTHOR]

المؤلفون: Kwok, Hoi Ming¹ (AUTHOR) hmkwok15@hotmail.com, Cheung, Chun Hei Lewey¹ (AUTHOR), Ng, Ting Fung¹ (AUTHOR), Lam, Sun Yu¹ (AUTHOR), Wong, Ka Hon Stephen¹ (AUTHOR), Wong, Ho Lim¹ (AUTHOR), Pan, Nin Yuan¹ (AUTHOR), Cheng, Lik Fai¹ (AUTHOR), Ma, Ka Fai Johnny¹ (AUTHOR)

المصدر: Pediatric Radiology. Apr2024, Vol. 54 Issue 4, p620-634. 15p.

مصطلحات موضوعية: *CHOLESTEATOMA, *MAGNETIC resonance imaging, *DELAYED diagnosis, *CONDUCTIVE hearing loss, *CHILD patients, *RADIOLOGISTS, *MASTOIDECTOMY

مستخلص: Congenital cholesteatoma is a rare, non-neoplastic lesion that causes conductive hearing loss in children. It is underrecognized and often diagnosed only when there is an established hearing deficit. In the pediatric population, hearing deficiency is particularly detrimental because it can impede speech and language development and, in turn, the social and academic well-being of affected children. Delayed diagnosis leads to advanced disease that requires more extensive surgery and a greater chance of recurrence. A need to promote awareness and recognition of this condition has been advocated by clinicians and surgeons, but no comprehensive imaging review dedicated to this entity has been performed. This review aims to discuss the diagnostic utility of high-resolution computed tomography and magnetic resonance imaging in preoperative and postoperative settings in congenital cholesteatoma. Detailed emphasis is placed on the essential preoperative computed tomography findings that facilitate individualized surgical management and prognosis in the pediatric population. [ABSTRACT FROM AUTHOR]

المؤلفون: Seki, Saori^1,2 (AUTHOR) saori526thu@yahoo.co.jp, Sugiyama, Tomonori¹ (AUTHOR), Kikuchi, Saori¹ (AUTHOR), Iino, Yukiko^1,3 (AUTHOR)

المصدر: Auris Nasus Larynx. Apr2024, Vol. 51 Issue 2, p295-300. 6p.

مصطلحات موضوعية: *EAR canal, *CHOLESTEATOMA, *OLDER patients, *OSTEOPOROSIS, *TYMPANIC membrane perforation, *AGE groups, *KIDNEY diseases

مستخلص: External auditory canal cholesteatoma (EACC) is characterized by retained squamous debris within the external canal and variable amounts of localized bone destruction. The etiology of primary EACC remains incompletely understood. This study was conducted to analyze the clinical features and backgrounds of patients with primary EACC and to clarify the risk factors for the occurrence and progression of EACC. Sixty-nine ears of 62 patients diagnosed with primary EACC were included in this study (EACC group). Additionally, 74 ears of 60 patients with chronic otitis media (COM) with perforation who underwent tympanoplasty or myringoplasty were included as controls (COM group). We retrospectively investigated the clinical features, life history, and medical history of the patients in both groups. In addition, to investigate the risk factors for progression of EACC, we compared the clinical features and medical history of patients with stage IV (advanced) disease versus stage I + II (mild) disease. The inferior wall of the bony canal was the main structure affected in patients with primary EACC of all stages. The following factors were significantly more common in the EACC than COM group: older age, female sex, left-sided disease, osteoporosis, renal dysfunction, anemia, and treatment with bisphosphonates. Among these, the most significant factor associated with EACC was renal dysfunction (odds ratio, 11.4; 95 % confidence interval, 2.32–55.9). The significant factors observed in patients with stage IV disease were younger age, male sex, posterior wall involvement, and otorrhea. Surgical treatment was required for more than half of the patients with stage III and IV EACC. Patients with renal dysfunction are at risk of primary EACC. In particular, younger patients and relatively younger elderly patients with posterior wall involvement have a risk of progression to advanced-stage EACC. Canalplasty should be considered in patients with EACC who have these risk factors to prevent progression to advanced-stage disease. [ABSTRACT FROM AUTHOR]