Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy (pdf)

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Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy

Braz J Otorhinolaryngol. 2018;84(5):608---613 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy夽 Sinan Uluyol a,∗ , Omer Ugur b , Ilker Burak Arslan b , Ozlem Yagiz b , Murat Gumussoy b , Ibrahim Cukurova b a b Van Training and Research Hospital, Department of Otorhinolaryngology, Van, Turkey Tepecik Training and Research Hospital, Department of Otorhinolaryngology, Izmir, Turkey Received 8 September 2016; accepted 18 July 2017 Available online 19 August 2017 KEYWORDS Caloric test; Epithelial migration; Quality of life Abstract Introduction: Canal wall down tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatoma. The advantages of canal wall down mastoidectomy are excellent exposure for disease eradication and postoperative control of residual disease; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, fungal cavity infections, and the occurrence of dizziness and vertigo by changing temperature or pressure. Objective: To evaluate whether cavity-induced problems can be eliminated and patient comfort can be increased with mastoid cavity reconstruction. Methods: In total, 11 patients who underwent mastoid cavity reconstruction between March 2013 and June 2013 comprised the study group, and 11 patients who had dry, epithelialized CWD cavities were recruited as the control group. The study examined three parameters: epithelial migration, air caloric testing, and the Glasgow Beneﬁt Inventory. Epithelial migration, air caloric testing, and the Glasgow Beneﬁt Inventory were evaluated in the study and control groups. Results: The epithelial migration rate was signiﬁcantly faster in study group (1.63 ± 0.5 mm/week) than control group (0.94 ± 0.37 mm/week) (p = 0.003, p < 0.05). The mean slow component velocity of nystagmus of the study group (13.33 ± 5.36◦ /s) was signiﬁcantly lower when compared to control group (32.11 ± 9.12◦ /s) (p = 0.018). The overall the Glasgow Beneﬁt Inventory score was −7.21, and the general subscale, physical and social health scores were −9.71, −21.09, and +20.35, respectively in the control group. These were +33.93, +35.59, +33.31, and +29.61, respectively in the study group. All but the social health score improved signiﬁcantly (0.007, 0.008, 0.018, and 0.181, respectively). 夽 Please cite this article as: Uluyol S, Ugur O, Arslan IB, Yagiz O, Gumussoy M, Cukurova I. Effects of cavity reconstruction on morbidity and quality of life after canal wall down tympanomastoidectomy. Braz J Otorhinolaryngol. 2018;84:608---13. ∗ Corresponding author. E-mail: (S. Uluyol). Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. https://doi.org/10.1016/j.bjorl.2017.07.007 1808-8694/© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Effects of cavity reconstruction on morbidity 609 Conclusions: Cavity reconstruction improves epithelial migration, normalizes caloric responses and increases the quality of life. Thus, cavity rehabilitation eliminates open-cavity-induced problems by restoring the functional anatomy of the ear. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE Prova calórica; Migração epitelial; Qualidade de vida Efeitos da reconstrução da cavidade da timpanomastoidectomia com técnica aberta na morbidade e qualidade de vida Resumo Introdução: A timpanomastoidectomia com a técnica Canal Wall Down, ou técnica aberta, é comumente utilizada para tratar otite média crônica avançada ou colesteatoma. As vantagens da mastoidectomia pela técnica aberta são uma excelente exposição para a erradicação da doença e controle pós-operatório da doença residual; suas desvantagens incluem o acúmulo de detritos que requerem manutenção e limpeza otológica ao longo da vida, drenagem contínua da orelha, infecções fúngicas na cavidade e a ocorrência de tonturas e vertigem com alterações de temperatura ou pressão. Objetivo: Avaliar se os problemas induzidos pela cavidade podem ser eliminados e o conforto do paciente aumentado com a reconstrução da cavidade mastoide. Método: No total, 11 pacientes submetidos à reconstrução da cavidade mastoide entre março de 2013 e junho de 2013 constituíram o grupo de estudo, e 11 pacientes com cavidades secas e epitelizadas, operadas pela técnica aberta, foram recrutados como grupo controle. O estudo analisou três parâmetros: migração epitelial, prova calórica com estimulação a ar e o questionário Glasgow Beneﬁt Inventory. A migração epitelial, a prova calórica e o Glasgow Beneﬁt Inventory foram avaliados nos grupos de estudo e controle. Resultados: A taxa de migração epitelial foi signiﬁcativamente mais rápida no grupo de estudo (1,63 ± 0,5 mm/semana) do que no grupo controle (0,94 ± 0,37 mm/semana) (p = 0,003, p < 0,05). A velocidade média do componente lento do nistagmo no grupo de estudo (13,33 ± 5,36◦ /s) foi signiﬁcativamente menor se comparada ao grupo controle (32,11 ± 9,12◦ /s) (p = 0,018). O escore global do Glasgow Beneﬁt Inventory foi de -7,21 e os escores da subescala geral, saúde física e social foram -9,71, -21,09 e +20,35, respectivamente, no grupo controle. Esses escores foram +33.93, +35.59, +33.31 e +29.61, respectivamente, no grupo de estudo. Todos, exceto o escore de saúde social, melhoraram signiﬁcativamente (0,007, 0,008, 0,018 e 0,181, respectivamente). Conclusões: A reconstrução da cavidade melhora a migração epitelial, normaliza as respostas da prova calórica e aumenta a qualidade de vida. Assim, a reabilitação da cavidade elimina os problemas induzidos por cavidades abertas ao restaurar a anatomia funcional da orelha. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob uma licença CC BY (http:// creativecommons.org/licenses/by/4.0/). Introduction Canal wall down (CWD) tympanomastoidectomy is commonly used to treat advanced chronic otitis media or cholesteatomas. The advantages of CWD mastoidectomy include excellent exposure for disease eradication and postoperative control of residual disease1,2 ; its disadvantages include the accumulation of debris requiring life-long otological maintenance and cleaning, continuous ear drainage, cavity infections, especially with fungal pathogens, and the occurrence of dizziness and vertigo induced by changing temperature or pressure.3 This study examined how well cavity reconstruction (...truncated)