2 articles
Chronic suppurative otitis media represents a major public health concern in both children and adults, particularly in developing countries. The condition poses not only a medical challenge requiring complex clinical management but also a public health issue with significant socioeconomic implications and costs.
A review of selected literature from the PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases was conducted. Articles published between 2000 and 2025 were selected using the following keywords: “chronic otitis media” and “chronic suppurative otitis media,” combined in various ways with the terms “surgical treatment,” “mastoidectomy,” “canal wall-down,” “canal wall-up,” “canal wall-intact,” “canal wall reconstruction,” “tympanoplasty,” and “ossiculoplasty” to maximize search efficiency. Based on the search criteria, 325 full-text articles were initially identified. The final bibliography included 66 relevant sources considered representative of the published material related to the topic of this review article.
There are four traditional surgical procedures for the treatment of chronic suppurative otitis media: 1) simple (cortical) mastoidectomy, 2) radical mastoidectomy, 3) modified radical mastoidectomy, and 4) mastoidectomy with tympanoplasty. These surgical interventions can be classified into two categories: open cavity (canal wall-down – CWD) and closed cavity (canal wall-up – CWU) or canal wall-intact (CWI). The CWD technique is the most effective method for cholesteatoma eradication, as it allows a wide-angle view of the mastoid and middle ear structures. Currently, radical CWD mastoidectomy is rarely performed but may be indicated when complete excision of the cholesteatoma is not possible. To prevent complications associated with the mastoid cavity following CWD, surgeons may opt for CWU mastoidectomy or CWD mastoidectomy with mastoid cavity obliteration and reconstruction of the external auditory canal wall.
The current concept of managing patients with chronic suppurative otitis media involves developing a personalized approach based on anatomical, biological, radiological, and social factors. The selection of the surgical technique should be tailored to each patient according to the location and extent of the cholesteatoma, defects of the posterior canal wall, associated lesions, presence of complications, degree of hearing loss, and the patient’s overall medical condition.
Acoustic neuroma is a benign tumor that arises from the glial Schwann sheath junction of the vestibulocochlear nerve. It has an incidence of 1:100000 population. Despite the fact that this is a rare tumor, it accounts for approximately 6% of all intracranial tumors and 80% of tumors localized in cerebellopontine angle. Treatment of acoustic neuroma is represented by “Wait and Scan” monitoring, radiologic and surgical treatment. The latter remains the primary treatment for acoustic neuroma and consists of 3 main approaches: retrosigmoid approach, middle cranial fossa approach and translabyrinthine approach. Until now, in our country, acoustic neuroma surgery was done only by retrosigmoid approach.
The first translabirinthine surgery for acoustic neuroma in our country was done on 09.12.2021 on a 60-year-old patient who, during preparation for cochlear implant surgery, was accidentally diagnosed with 3rd grade right acoustic neuroma, according to Koos classification. Patient had cophosis on the right ear and moderate hearing loss in the left ear. During the surgery, a gross total resection of the tumor was accomplished. The patient was discharged from the medical institution on 20.12.2021 in a satisfactory condition. Magnetic resonance imaging performed 3 months and 1 year after the surgery showed no complications or tumor remnants.
The current report, which describes an accidental diagnosis of acoustic neuroma during preparation for a cochlear implantation surgery, resulted in acoustic neuroma surgery through the translabyrinthine approach. This serves as an eloquent example of why it is necessary to perform initially a magnetic resonance examination in cases of sensorineural hearing loss or tinnitus. The translabyrinthine approach in acoustic neuroma surgery allows for the removal of tumors of any size without affecting the brain, especially the cerebellum. In our case, where the patient had cophosis on the side of the tumor, this was the most appropriate surgical approach.