“Benefits of the pedicled osteoplastic flap as a surgical approach of mastoidectomy in cochlear implant surgery”

Objective: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. Study design: Double-blind, prospective, randomized clinical trial. Setting: tertiary referral center. Intervention(s): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. Main outcome measure(s): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. Results: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. Conclusions: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.

Palavras-chave

Acoustic impedance tests, Cochlear implant, Esthetics, Mastoidectomy, Surgical flap, Wound healing

URI

https://observatorio.fm.usp.br/handle/OPI/58630

Referências

Yuen H.W., Chen J.M., Reconstructive options for skull defects following translabyrinthine surgery for vestibular schwannomas, Curr Opin Otolaryngol Head Neck Surg, 16, 4, pp. 318-324, (2008)
Hongo T., Komune N., Shimamoto R., Nakagawa T., The surgical anatomy of soft tissue layers in the mastoid region, Laryngoscope Investig Otolaryngol, 4, 3, pp. 359-364, (2019)
Magnuson B., Functions of the mastoid cell system: auto-regulation of temperature and gas pressure, J Laryngol Otol, 117, 2, pp. 99-103, (2003)
Eden A.R., Laitman J.T., Gannon P.J., Mechanisms of middle ear aeration: anatomic and physiologic evidence in primates, Laryngoscope, 100, 1, pp. 67-75, (1990)
Seibert J.W., Danner C.J., Eustachian tube function and the middle ear, Otolaryngol Clin North Am, 39, 6, pp. 1221-1235, (2006)
Stratigouleas E.D., Perry B.P., King S.M., Syms C.A., Complication rate of minimally invasive cochlear implantation, Otolaryngol Head Neck Surg, 135, 3, pp. 383-386, (2006)
Doyle W.J., The mastoid as a functional rate-limiter of middle ear pressure change, Int J Pediatr Otorhinolaryngol, 71, 3, pp. 393-402, (2007)
Doyle W.J., A formal description of middle ear pressure-regulation, Hear Res, 354, pp. 73-85, (2017)
Gaihede M., Dirckx J.J., Jacobsen H., Aernouts J., Sovso M., Tveteras K., Middle ear pressure regulation–complementary active actions of the mastoid and the Eustachian tube, Otol Neurotol, 31, 4, pp. 603-611, (2010)
Sade J., Fuchs C., Secretory otitis media in adults: II. The role of mastoid pneumatization as a prognostic factor, Ann Otol Rhinol Laryngol, 106, 1, pp. 37-40, (1997)
Sade J., The correlation of middle ear aeration with mastoid pneumatisation. The mastoid as a pressure buffer, Eur Arch Otorhinolaryngol, 249, 6, pp. 301-304, (1992)
Alper C.M., Kitsko D.J., Swarts J.D., Martin B., Yuksel S., Cullen Doyle B.M., Villardo R.J., Doyle W.J., Role of the mastoid in middle ear pressure regulation, Laryngoscope, 121, 2, pp. 404-408, (2011)
Fearmonti R.M., Bond J.E., Erdmann D., Levin L.S., Pizzo S.V., Levinson H., The modified patient and observer scar assessment scale: a novel approach to defining pathologic and nonpathologic scarring, Plast Reconstr Surg, 127, 1, pp. 242-247, (2011)
Minoda R., Yanagihara N., Hinohira Y., Yumoto E., Efficacy of mastoid cortex plasty for middle ear aeration in intact canal wall tympanoplasty for cholesteatoma, Otol Neurotol, 23, 4, pp. 425-430, (2002)
Koc A., Ekinci G., Bilgili A.M., Akpinar I.N., Yakut H., Han T., Evaluation of the mastoid air cell system by high resolution computed tomography: three-dimensional multiplanar volume rendering technique, J Laryngol Otol, 117, 8, pp. 595-598, (2003)
Terzi S., Ozgur A., Erdivanli O.C., Coskun Z.O., Ogurlu M., Demirci M., Dursun E., Diagnostic value of the wideband acoustic absorbance test in middle-ear effusion, J Laryngol Otol, 129, 11, pp. 1078-1084, (2015)
Bento R.F., Tsuji R.K., Fonseca A.C., Alves R.D., Use of an osteoplastic flap for the prevention of mastoidectomy retroauricular defects, Int Arch Otorhinolaryngol, 21, 2, pp. 151-155, (2017)
Hopfenspirger M.T., Levine S.C., Rimell F.L., Infectious complications in pediatric cochlear implants, Laryngoscope, 117, 10, pp. 1825-1829, (2007)
Vila P.M., Ghogomu N.T., Odom-John A.R., Hullar T.E., Hirose K., Infectious complications of pediatric cochlear implants are highly influenced by otitis media, Int J Pediatr Otorhinolaryngol, 97, pp. 76-82, (2017)
Rubin L.G., Papsin B., Section on otolaryngology–head and neck surgery. Policy statement—Cochlear implants in children: surgical site infections and prevention and treatment of acute otitis media and meningitis, Pediatrics, (2010)
Ars B., Wuyts F., Van de Heyning P., Miled I., Bogers J., Van Marck E., Histomorphometric study of the normal middle ear mucosa. Preliminary results supporting the gas-exchange function in the postero-superior part of the middle ear cleft, Acta Otolaryngol, 117, 5, pp. 704-707, (1997)
Kim S.Y., Han J.J., Oh S.H., Lee J.H., Suh M.W., Kim M.H., Park M.K., Differentiating among conductive hearing loss conditions with wideband tympanometry, Auris Nasus Larynx, 46, 1, pp. 43-49, (2019)
Ellison J.C., Gorga M., Cohn E., Fitzpatrick D., Sanford C.A., Keefe D.H., The wideband acoustic transfer functions predict middle-ear effusion, Laryngoscope, 122, 4, pp. 887-894, (2012)
Prieve B.A., Feeney M.P., Stenfelt S., Shahnaz N., Prediction of conductive hearing loss using wideband acoustic immittance, Ear Hear, 34, pp. 54S-59S, (2013)
Hunter L.L., Prieve B.A., Kei J., Sanford C.A., Pediatric applications of wideband acoustic immittance measures, Ear Hear, 34, pp. 36S-42S, (2013)

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Artigos e Materiais de Revistas Científicas - FM/MOF
Artigos e Materiais de Revistas Científicas - FM/MFT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InRad
Artigos e Materiais de Revistas Científicas - LIM/32
Artigos e Materiais de Revistas Científicas - LIM/34

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