HSC Section 8_April 2017

Tarazi AE, Al-Tawfiq JA, Abdi RF. Fungal malignant otitis externa: pitfalls, diagnosis, and treatment. Otol Neurotol . 2012; 33(5):769-773. EBM level 4.............................................94-98

Summary : This study reviews literature on malignant otitis externa (MOE), including fungal infections, and reports the findings as a series of case presentations on patients with Aspergillus MOE. Oral voriconazole was found to be a viable alternative treatment to intravenous vancomycin and amphotericin B. The authors discuss pitfalls, diagnosis, and treatment of MOE associated with Pseudomonas aeruginosa as well as to fungi. B. Cholesteatoma Crowson MG, Ramprasad VH, Chapurin N, et al. Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma. Laryngoscope . 2016; 126(11):2574- 2579. EBM level 4...............................................................................................................99-104 Summary : This article examines a single institution’s experience managing patients with cholesteatoma through an intact canal wall tympanoplasty with mastoidectomy. The authors explore differences in hearing outcomes, disease recidivism, and overall costs between patients undergoing a single-stage surgical procedure and a second-look operative approach. Hearing outcomes were similar between these groups, while costs were considerably lower with the single-stage group and disease recidivism was higher for the group undergoing a second-look procedure. The article stresses the need for individualizing the approach based on the level of disease present at the time of the initial surgery. Kerckhoffs KG, Kommer MB, van Strien TH, et al. The disease recurrence rate after the canal wall up or canal wall down technique in adults. Laryngoscope . 2016; 126(4):980-987. EBM level 3..................................................................................................................................105-112 Summary : This is a systematic review article that examines the literature on the topic of disease recidivism following canal wall up and canal wall down mastoidectomy for acquired cholesteatoma. The article highlights the variability in the available literature, but demonstrates that recidivistic disease is more likely in canal wall up mastoidectomy techniques. While both canal wall up and canal wall down techniques are associated with recidivistic disease, residual cholesteatoma is more common in canal wall up techniques, while recurrent disease is more common in canal wall down techniques. Migirov L, Wolf M, Greenberg G, Eyal A. Non-EPI DW MRI in planning the surgical approach to primary and recurrent cholesteatoma. Otol Neurotol . 2014; 35(1):121-125. EBM level 4..................................................................................................................................113-117 Summary : This article assesses the accuracy of non-echo planar, diffusion-weighted MRI for assessing primary and recurrent/residual cholesteatoma in a cohort of 50 patients. The authors compared preoperative MRI findings with intraoperative findings to determine the degree of accuracy, with a finding of 98% concordance.