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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.