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Purpose The opportunities for surgical training and practice in the operating room are in decline due to limited resources, increased efficiency demands, growing complexity of the cases, and concerns for patient safety. Virtual reality (VR) offers a novel opportunity to enhance surgical training and provide complementary three-dimensional experience that has been usually available in the operating room. Since VR allows viewing and manipulation of realistic 3D models, the VR environment could enhance anatomical and topographical knowledge, in particular. In this study, we explored whether incorporating VR anatomy training improves novices’ performance during mastoidectomy over traditional methods. Methods Thirty medical students were randomized into two groups and taught mastoidectomy in a structured manner. One group utilized a VR temporal bone model during the training while the other group used more traditional materials such as anatomy books. After the training, all participants completed a mastoidectomy on a 3D-printed temporal bone model under expert supervision. Performance during the mastoidectomy was evaluated with multiple metrics and feedback regarding the two training methods was gathered from the participants. Results The VR training method was rated better by the participants, and they also needed less guidance during the mastoidectomy. There were no significant differences in operational time, the occurrence of injuries, self-assessment scores, and the surgical outcome between the two groups. Conclusion Our results support the utilization of VR training in complete novices as it has higher trainee satisfaction and leads to at least as good results as the more traditional methods.

This study aimed to investigate the effects of automated metrics-based summative feedback on performance, retention and cognitive load in distributed virtual reality simulation training of mastoidectomy. Twenty-four medical students were randomised in two groups and performed 15 mastoidectomies on a distributed virtual reality simulator as practice. The intervention group received additional summative metrics-based feedback; the control group followed standard instructions. Two to three months after training, participants performed a retention test without learning supports. The intervention group had a better final-product score (mean difference = 1.0 points; p = 0.001) and metrics-based score (mean difference = 12.7; p < 0.001). At retention, the metrics-based score for the intervention group remained superior (mean difference = 6.9 per cent; p = 0.02). Also at the retention, cognitive load was higher in the intervention group (mean difference = 10.0 per cent; p < 0.001). Summative metrics-based feedback improved performance and lead to a safer and faster performance compared with standard instructions and seems a valuable educational tool in the early acquisition of temporal bone skills.

To correlate pre-operative computed tomography findings, intra-operative details and surgical outcomes with cholesteatoma recurrence in revision tympanomastoidectomy. This retrospective, non-randomised, single-institution cohort study included 42 patients who underwent pre-operative computed tomography imaging and revision surgery for recurrent chronic otitis media. Twelve disease localisations noted during revision surgery were correlated with pre-operative temporal bone computed tomography scans. A matched pair analysis was performed on patients with similar intra-operative findings, but without pre-operative computed tomography scans. Pre-operative computed tomography identified 25 out of 31 cholesteatoma recurrences. Computed tomography findings correlated with: recurrent cholesteatoma when attic opacification and ossicular chain involvement were present; and revision surgery type. Sinodural angle disease, posterior canal wall erosion and dehiscent dura were identified as predictors of canal wall down tympanomastoidectomy. Patients with pre-operative computed tomography scans had a higher rate of cholesteatoma recurrence, younger age at diagnosis of recurrent disease, more revision surgical procedures and less time between previous and revision surgical procedures (all p < 0.05). Pre-operative imaging and intra-operative findings have important clinical implications in revision surgery for chronic otitis media. Performing pre-operative computed tomography increases diagnosis accuracy and reduces the time required to diagnose recurrent disease.

Canal wall down mastoidectomy is a surgical technique used for the eradication of middle ear disease. The remaining large mastoid bowl is associated with a number of issues; one of the main techniques that have been developed in order to avoid such problems is the obliteration of the mastoid cavity. The materials used for this reason are either biological or synthetic. The purpose of this survey is to review the published literature related to the therapeutic value of mastoid obliteration with synthetic materials. We searched Web of Science, PubMed, and MEDLINE from 2008 to 2018 using the criteria mastoid obliteration, canal wall down mastoidectomy, chronic otitis media, and cholesteatoma. The search focused on papers concerning the mastoid obliteration with synthetic material, as we focused on looking for outcomes and reported complications. Out of a total of 244 citations, 15 articles were identified, where patients underwent mastoid obliteration with synthetic materials. Most authors used bioactive glass as a filler material. Mastoid obliteration resulted in a decrease in the complications associated with the open mastoid cavity. On the basis of the available limited literature, it seems that mastoid obliteration with synthetic materials is a valuable and safe surgical technique for patients who undergo canal wall down mastoidectomy. The bioactive glass appears to be the most reliable synthetic material.

IntroductionRadical mastoidectomy is a common procedure for chronic suppurative otitis media, typically performed under a microscope. The smooth operation is closely related to the clarity of the operative field. Our trial is designed to investigate whether the intravenous administration of tranexamic acid (TXA) can improve the clarity of the operative field, reduce the operative time, and increase surgeon satisfaction.Methods and analysisThis study is a prospective, randomised, double-blinded, controlled trial that aims to investigate the effects of TXA on patients with otitis media. The trial will include patients between the ages of 18 and 65 who will be randomly assigned to either the TXA group or the control group. In the TXA group, patients will receive 1 g of TXA diluted to 20 mL of normal saline before anaesthesia induction while the control group will receive 20 mL of normal saline. The primary outcome measure will be the Modena Bleeding Score, which will assess the clarity of the surgical field. Secondary outcomes will include the surgeon’s satisfaction with surgical conditions, operation time, laboratory measurements (prothrombin time, activated partial thromboplastin time, fibrin degradation products, D-dimer) and levels of inflammatory factors (such as IL-6) at 24 hours postoperatively. In addition, the incidence of general adverse reactions such as postoperative nausea, vomiting and dizziness; serious adverse events such as arterial and venous thromboembolism, myocardial infarction and epilepsy within 90 days will be compared between the two groups.Ethics and disseminationThe protocol was approved by the Ethics Committee of Peking University People’s Hospital (2021PHB173-001), on 19 July 2021. The trial results will be submitted for publication in a peer-reviewed journal.Trial registration numberChiCTR2100049183.

Objectives: To compare the graft uptake rates and hearing outcomes in cases of tubotympanic chronic otitis media undergoing Tympanoplasty with and without Cortical mastoidectomy.Materials & Methods: It was a prospective study carried out over the period 1 year from 2012-13 with a sample size was 50 patients. Patients were randomised into Group A(tympanoplasty group) or group B(Tympanoplasty with cortical mastoidectomy group). Independent two sample T test was used to compare post operative graft uptake rates and hearing outcomes in the two groups.Results: Post operative graft uptake rates at the end of 6 months and mean hearing gain were found comparable in both groups (p>0.05).Conclusion: Tympanoplasty alone is sufficient in patients with tubotympanic type of chronic otitis media, as the results of graft uptake and hearing improvement show no significant difference between the tympanoplasty and cortical mastoidectomy group.

Mastoidectomy is considered an aerosol-generating procedure. This study examined the effect of wearing personal protective equipment on the view achieved using the operating microscope. ENT surgeons assessed the area of a calibrated target visible through an operating microscope whilst wearing a range of personal protective equipment, with prescription glasses when required. The distance between the surgeon's eye and the microscope was measured in each personal protective equipment condition. Eleven surgeons participated. The distance from the eye to the microscope inversely correlated with the diameter and area visible (p < 0.001). The median area visible while wearing the filtering facepiece code 3 mask and full-face visor was 4 per cent (range, 4-16 per cent). The full-face visor is incompatible with the operating microscope. Solutions offering adequate eye protection for aerosol-generating procedures that require the microscope, including mastoidectomy, are urgently needed. Low-profile safety goggles should have a working distance of less than 20 mm and be compatible with prescription lenses.

Purpose Despite the declining incidence of acute mastoiditis (AM) due to antibiotics, complications persist, necessitating surgical intervention in severe cases. Recent studies suggest conservative treatments, avoiding mastoidectomy, show high recovery rates. However, this trend raises concerns about severe complications, prolonged treatment, increased antibiotic use, and declining surgical skills. While much research focuses on AM pathogenesis and treatment, the long-term consequences, especially post-mastoidectomy ear function, are less understood. To address this, we studied the permanent effects of surgically treated AM and mastoidectomy on ear function. Methods A cohort of patients that received surgical treatment for AM in the form of mastoidectomy was invited to be tested after at least 5 years since the operation. Test battery included COMQ-12 questionnaire, physical exam and otomicroscopy, extended high pure tone audiogram, DPAOE and middle ear impedance testing. Results were compared with a control group and a group which received surgical treatment in the form of tympanostomy for acute otitis media with impeding mastoiditis. Results The COMQ-12 questionnaire yielded higher scores in questions about hearing in quiet environments, hearing in noise, tinnitus, and ear discomfort. Minor structural changes were observed in the test groups during otomicroscopy, but not in the control group. Pure tone audiometry revealed a median elevation of around 10 dB in high and extended high frequencies, with similar results observed in DPAOE testing. In middle ear impedance testing, only an elevation of the stapedial reflex threshold was noted; other tests did not show any statistically significant differences. Conclusions In the long term, the majority of patients post-AM have minor functional in structural consequences. In the context of treatment of AM, the effects of mastoidectomy are negligible when compared to less invasive surgical procedures.

Objectives This study aims to compare results of endoscopic transcanal tympanoplasty with attico-antrostomy with endoscopic-assisted canal wall up mastoidectomy in treatment of cases of limited attic cholesteatoma. Materials and methods A prospective randomized single-blinded study involving 40 patients with limited attic cholesteatoma was conducted. Randomization of the patients into two groups was done; 20 patients are managed by endoscopic transcanal tympanoplasty with attico-antrostomy, while the other 20 patients are managed by endoscopic-assisted canal wall up mastoidectomy. Primary outcome is recidivism, while secondary outcomes include hearing results, operative time, pain score and associated complications. Results Comparable recidivism rate was found in the two groups. The endoscopic-assisted canal wall up mastoidectomy group was associated with significantly longer duration of surgery and higher postoperative pain score. There was no significant difference between both the groups regarding hearing results and associated complications. Conclusion In localized attic cholesteatoma cases, endoscopic transcanal tympanoplasty with attico-antrostomy is a time-saving less-invasive reliable technique with good eradication results. Clinical trial registry ClinicalTrials.gov (NCT04959539) “retrospectively registered” at 12/7/2021.

Postoperative pain is one of the most important factors in the recovery process after surgery. The incision site of tympano-mastoidectomy is related to the innervation of the superficial cervical plexus. The aim of this study is to evaluate the effect of superficial cervical plexus block on reducing post-tympano-mastoidectomy pain. This is a prospective, double-blind clinical trial study, and patients aged 20-61 years who were candidates for tympano-mastoidectomy were included in the study and were randomly divided into two groups. Before induction of general anesthesia, the subjects underwent superficial cervical plexus block with ultrasound guidance, injection of ropivacaine 0.2% in the treatment group, and normal saline in the control group, respectively. Hemodynamic parameters, intraoperative remifentanil used to maintain hemodynamic stability, the severity of perioperative pain, nausea and vomiting, and perioperative analgesic use were compared between the two groups. Pain intensity in the recovery phase, 2, 6, 12, and 24 hours after surgery in the treatment was 2.6, 1.8, 1.4, 0.5, and 0.4 and in the control, group was 3.7, 2.5, 2.1, 1.5, and 0.9, respectively (P<0.05). Intraoperative use of remifentanil was 410±622.2 µg in the block group and 1340±448.4 µg in the control group, respectively. The need for opioid administration was 8.2±10.4 mg in the block group and 13±13.2 mg in the control group, respectively (P=0.046). The need for administration of diclofenac in the first 24 hours after surgery was 8±27.4 mg in the treatment group and 54±50 mg in the control group, respectively (P<0.001). Superficial cervical plexus block can significantly reduce pain and the need for opioid administration after the tympano-mastoidectomy operation.