Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Otol Neurotol. 2019 Oct;40(9):e901-e908. doi: 10.1097/MAO.0000000000002354.
Identify features on computed tomography (CT) that predict mastoidectomy conversion (MC) during transcanal endoscopic ear surgery (TEES).
Retrospective case-control.
University otology practice.
Consecutive patients with cholesteatoma.
TEES cholesteatoma dissection versus those requiring MC.
Antrum opacification, depth of scutum involvement, and erosion of the mastoid trabeculae, ossicular chain, and tegmen were evaluated. Univariable and multivariable regression analysis was performed. The Antrum-Malleus-Tegmen (AMT) score was created using receiver operating characteristic curves to assess feasibility of performing TEES for cholesteatoma dissection.
There were 39 TEES and 19 MC cases. Groups had similar age (median 28.5 yr), gender, laterality, and revision surgery status. Median surgical time for MC cases was longer than TEES (231 min vs. 171 min, p < 0.001). Radiographic predictors of MC by multivariable regression included antrum opacification (p = 0.036), malleus erosion (p = 0.044), and tegmen erosion (p = 0.023). The AMT score predicted the feasibility of TEES without MC with a sensitivity of 90% and specificity of 75% when ≥2 of the following conditions were met on preoperative CT: intact tegmen, intact malleus, and absence of antrum opacification.
An aerated antrum, intact malleus, and intact tegmen suggest that TEES cholesteatoma dissection without the need for mastoidectomy is highly likely. A score of ≥2 on the AMT score predicts this with a positive predictive value of 88% and negative predictive value of 78%.
确定经耳道内镜（TEES）中耳乳突切除术（MC）转换（MC）的 CT 预测因素。
回顾性病例对照。
大学耳科实践。
连续的胆脂瘤患者。
TEES 胆脂瘤解剖与需要 MC 的患者。
评估窦腔混浊、盾板受累深度以及乳突小梁、听小骨链和鼓室盖的侵蚀。进行单变量和多变量回归分析。使用接收者操作特征曲线创建了窦腔-锤骨-鼓室盖（AMT）评分，以评估 TEES 进行胆脂瘤解剖的可行性。
TEES 有 39 例，MC 有 19 例。两组患者的年龄（中位数 28.5 岁）、性别、侧别和翻修手术状态相似。MC 病例的手术时间中位数长于 TEES（231 分钟比 171 分钟，p < 0.001）。多变量回归分析的 MC 放射学预测因子包括窦腔混浊（p = 0.036）、锤骨侵蚀（p = 0.044）和鼓室盖侵蚀（p = 0.023）。当术前 CT 满足以下条件中的 2 个或更多时，AMT 评分可预测无需 MC 的 TEES 可行性，其灵敏度为 90%，特异性为 75%：完整的鼓室盖、完整的锤骨和无窦腔混浊。
充气窦腔、完整的锤骨和完整的鼓室盖表明，TEES 胆脂瘤解剖无需行乳突切除术的可能性很高。AMT 评分≥2 分可预测这一点，阳性预测值为 88%，阴性预测值为 78%。
