Quality of life after revision mastoidectomy with mastoid obliteration

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"Pontillo" "email" => array:1 [ 0 => "pontillovito@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Sabino" "apellidos" => "Ciprelli" ] 2 => array:2 [ "nombre" => "Rossella" "apellidos" => "Grillo" ] 3 => array:2 [ "nombre" => "Nicola" "apellidos" => "Quaranta" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calidad de la vida después mastoidectomia de revisión con obliteración mastoidea" ] ] "textoCompleto" => "IntroductionCanal wall up (CWU) and canal wall down (CWD) tympano-mastoidectomies are the main surgical approaches currently in use for the treatment of middle ear and mastoid cholesteatoma. Both techniques present several benefits and drawbacks and the debate on the best surgical technique is still ongoing. CWD offers the advantage of a lower risk of recurrence compared to CWU,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> but the need for periodic cleanings and aspirations, the recurrence of infections with malodorous drainage, the inability to wear conventional hearing aids and the exposure to caloric-effect vertigo can seriously affect the patients’ quality of life (QoL).<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Mastoid obliteration has been proposed with the aim of reducing the cavity size, thus minimizing these major issues and decreasing at the same time the risk of recurrence.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Obliterative techniques have been broadly criticized for their possible negative implications in the surveillance of eventual recurrence, but have gained increasing popularity in the last few years, after the development of diffusion-weighted magnetic resonance (MR) techniques.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>Revision tympano-mastoidectomy is indicated in case of relapse of cholesteatoma or troublesome mastoid cavity.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> In these circumstances, mastoid obliteration has been proposed as an effective technique. Although several authors have reported on the effects of secondary obliteration on the traditional functional and anatomical outcomes,<a class="elsevierStyleCrossRefs" href="#bib0030">6–9</a> its impact on the postoperative QoL has been rarely evaluated so far.The main aim of the present study was to evaluate the postoperative QoL in a group of patients who had undergone revision mastoidectomy with mastoid obliteration; in addition, the role of the surgical technique performed at primary surgery (CWU vs. CWD) was evaluated.Materials and methodsData collectionA retrospective chart analysis was performed including all patients who underwent a revision CWD with mastoid obliteration in our department between January 2016 and December 2019. All patients had been previously operated for cholesteatoma by CWU or CWD without obliteration and had developed recurrence or troublesome mastoid cavity. A control group was selected in order to have a term of comparison, by including all the patients who underwent primary CWD with mastoid obliteration for cholesteatoma in the same department between January 2009 and December 2014.All patients had undergone a complete preoperative assessment, including otoscopy under microscope magnification, pure tone audiometry, high-resolution computed tomography (CT) of the temporal bone. MR imaging is not routinely performed in our centre, but limited to cases with intracranial complications or suspected meningocele. The preoperative hearing function and symptoms, the type of surgery and the intra-operative findings, together with the postoperative serial follow-up findings and hearing thresholds were collected from medical records and integrated in an electronic database.Pure-tone average (PTA) values were calculated as the mean of 0.5, 1, 2, and 4kHz thresholds, while Air-Bone Gap (ABG) as the difference between air conduction PTA (PTAAC) and bone conduction PTA (PTABC) obtained at each evaluation. Delta-BC was calculated as the difference between the postoperative and preoperative average BC thresholds at 1, 2 and 4kHz, as the possible expression of a sensorineural iatrogenic damage. ABG gain was calculated as the difference between preoperative and postoperative ABG. All data were presented in accordance with the recommendations from the Hearing Committee of the American Academy of Otolaryngology–Head and Neck Surgery for the evaluation of conductive hearing loss.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Surgical techniquesA detailed description of the surgical technique of CWD with primary obliteration has been published previously.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> In brief, after mastoidectomy and antrostomy, the posterior-superior wall of the bony external auditory canal is removed and lowered to the level of the facial nerve, and the anterior epitympanum is exteriorized. An anterior and inferior canaloplasty is performed and the borders of the mastoidectomy are smoothed. Once the cholesteatoma is removed, the tympanic membrane is reconstructed with a large piece of fascia and the mastoid cavity filled with triangles of bone paste made of the previously harvested bone dust from the cortical mastoidectomy, blood, and fibrin glue. The bone paste is then covered with fascia or bovine pericardium (Lyoplant; B. Braun Melsungen AG, Melsungen, Germany) to prevent contact with the skin. An adequate meatoplasty is performed, and the cavity is packed with gelatine sponge.Revision mastoidectomy in patients previously operated by CWU requires the removal of the posterior canal wall and the removal of the recurrent disease when present. The cavity is then regularized by lowering the posterior bone to the level of the facial nerve and drilling the epitympanic bone, the tympanic membrane reconstructed, and the mastoid cavity partially obliterated with bone paste. Meatoplasty is performed in all cases.In case of previous CWD or radical mastoidectomy, the revision surgery requires the correction of the anatomical defects, such as an incomplete drilling over the facial nerve (high facial “ridge”) or an irregular mastoid cavity, and the removal of pathological tissue, as suggested by Bhatia et al.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Then, the tympanic membrane and middle ear space are reconstructed, and the mastoid cavity partially obliterated with bone paste. Revision meatoplasty should be performed when needed. Staging is planned intra-operatively depending on the status of the middle ear mucosa or the location of cholesteatoma.Quality of life assessmentThe Chronic Otitis Media Questionnaire 12 (COMQ-12), proposed by Phillips et al.,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> translated in different languages including Italian<a class="elsevierStyleCrossRef" href="#bib0070">14</a> and validated by a multicentric assessment from eight different countries<a class="elsevierStyleCrossRef" href="#bib0075">15</a> was used to evaluate the QoL. It is a 12-item questionnaire, divided in four different categories: severity of symptoms, specific impact on work and lifestyle, impact on the health service, and general impact on the patient. Based on the degree of inconvenience or frequency of symptoms, each question is scored on a six-point scale from 0 (no impact or sporadic occurrence) to 5 (most severe impact or daily occurrence).Due to SARS-CoV2 pandemic restrictions, all patients were contacted by telephone and received appropriate and comprehensible information about the study. An online or printed template of the previously validated Italian version of the COMQ-12 questionnaire<a class="elsevierStyleCrossRef" href="#bib0070">14</a> was addressed, together with a written agreement form, to those who had given their oral consent by telephone. Replies and signed informed consent were received by the same modalities. Thus, the overall COMQ-12 score was calculated for each case, by adding the single answer scores. The study was approved by the local Ethics Committee (PROT 4799/2019) and was carried out in accordance with the Declaration of Helsinki.Study design and statistical analysisIn order to evaluate the role of secondary mastoid obliteration, revision cases were compared with primary CWD with mastoid obliteration in terms of QoL and in terms of the anatomical and hearing outcomes. In addition, an intra-group comparison was performed within the revision cohort between two subgroups, based on the technique used at primary surgery (CWU vs. CWD).Categorical or dichotomous variables were expressed as absolute number and percentage (N, %). Continuous variables were expressed as mean±standard deviation (μ±SD). Fisher’s exact test was used to compare categorical variables, Mann–Whitney test to compare continuous variables. A p-value <0.05 was considered as statistically significant. The software IBM SPSS Statistics (Version 26) was used for statistical analysis.ResultsPrimary vs. revision CWD with obliterationThe study group consisted of 38 patients (20 males and 18 females) with a mean age of 42.05±19.41 years (mean±SD) at the time of the revision surgery. Average clinical postoperative follow-up was 29.8±6 months (mean±SD), while the COMQ-12 was recorded on average 37.2±7.3 months (mean±SD) after the surgery.The control group consisted of 78 (45 males and 33 females) patients with a mean age of 46.25±19.41 years (mean±SD). Average clinical postoperative follow-up was 61.7±32 months (mean±SD), while the COMQ-12 was recorded on average 86.1±23.5 months (mean±SD) after the surgery.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> reports the demographics of the two groups as well as the main intraoperative findings. Statistical analysis showed that the two groups were not significantly different in terms of age, sex and affected side, as well as in terms of intra-operative findings and in the rate of patients that completed the reconstructive time of surgery.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In the primary CWD group residual cholesteatoma occurred in 5 cases (6.4%) and long-term anatomical complications, such as tympanic membrane retraction or lateralisation, granulations, or serous otitis media, in 10 cases (12.8%). In the revision CWD group no cases of residual or recurrent cholesteatoma were recorded. In 2 cases (5.3%) a dehiscence of the tympanic membrane was evident at last clinical follow-up, in the remaining cases a dry and clean cavity with an intact TM was found. No cases of necrosis, infection or extrusion of the obliterated cavity were recorded in the two groups. Statistical analysis did not show a statistical difference between the two groups in terms of anatomical complications (p-value >0.05).<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> (left side) reports pre- and post-operative hearing results in the two groups. Both pre- and post-operative thresholds did not significantly differ between the primary and revision CWD with obliteration, except for a trend towards significance for the higher pre- (33.3 vs. 27.9, p-value 0.043) and post-operative ABGs (29.7 vs. 25.2, p-value 0.046) in the revision group compared to the primary CWD group.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> (left side) reports the COMQ-12 scores in the study group and control group. The total COMQ-12 score was not significantly different between the two groups (9.1 vs. 10.46), but revision patients reported significantly higher scores at Question 6 (‘Dizziness or feeling of off-balance’, 0.8 vs. 0.5, p-value 0.019), Question 9 (‘How often have you been fearful of washing or having shower causing an ear infection?’, 1 vs. 0.8, p-value 0.007), Question 10 (‘How often have you been to see your GP about your ear problems?’, 0.6 vs. 0.2, p-value <0.001) and Question 11 (‘How often do you need to take medicines for your ear problem?’, 0.2 vs. 0.1, p-value 0.018).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Revision mastoidectomy after CWU vs. revision mastoidectomy after CWD<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> reports the reason for revision surgery according to the primary surgical technique. Among patients who underwent revision surgery, 23 had been initially treated by CWU and 15 by CWD, including 11 cases of radical mastoidectomy. Reasons for revision after CWU were recurrent cholesteatoma in 18 cases (78%) and residual cholesteatoma in 3 cases (13%), while a hyperplastic otitis media was found in 2 cases (9%). Reasons for revision after CWD were troublesome mastoid cavity in 11 cases (73%) and recurrent cholesteatoma in 4 (27%). The most frequent cavity problems were frequent debris accumulation with recurrent discharge in 6 cases (54.5%) and recurrent vertigo in 5 cases (45.5%). In no case the mastoid was found to be previously obliterated. Statistical analysis showed that recurrent cholesteatoma was the reason for revision surgery more frequently in patients who had undergone CWU as primary intervention, compared to those who had undergone primary CWD (78.3% vs. 26.7%, p-value 0.005).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> (right side) reports pre- and post-revision hearing results in the two subgroups. Preoperative PTABC was significantly higher in patients previously submitted to CWD compared to those who had undergone a CWU (27.3 vs. 19.8, p-value 0.035), while all other values were not significantly different between the two subgroups. Despite the lack of statistical significance, the postoperative PTAAC (60.5 vs. 55.1) and PTABC (31.6 vs. 24.6) were higher in the CWD subgroup.The postoperative COMQ-12 scores in the two subgroups are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> (right side). After revision CWD with obliteration, patients previously operated by CWD presented a significantly worse overall COMQ-12 score compared to patients initially treated by CWU (13.9 vs. 8.4, p-value 0.013) and also significantly higher subscores at Question 3 (‘Hearing problems at home’, 2.1 vs. 1, p-value 0.008), Question 4 (‘Hearing problems when talking to people in groups or there are noisy surroundings’, 2.6 vs. 1.3, p-value 0.003) and Question 6 (‘Dizziness or feeling off-balance’, 1.3 vs. 0.5, p-value 0.049).DiscussionSurgical management of cholesteatoma is one of the most challenging domains for an otologist. Several techniques have been proposed, each one with its own advantages and disadvantages,<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> all sharing the common aims of the complete removal of the matrix, the reconstruction of a a dry and safe middle ear and the restoration of a socially acceptable hearing level. These three traditional goals of cholesteatoma surgery, when achieved, result in a veritable benefit in patients’ QoL. Revision surgery retains the same three goals but can be even more challenging since the surgeon must deal with an altered anatomy and distorted surgical landmarks.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Anatomical complications, such as residual and recurrent disease or troublesome mastoid cavities, represent the most common indications for revision surgery.The advantages of primary mastoid obliteration have already been discussed in a previous work.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> In the present study the results of revision mastoidectomy with mastoid obliteration were evaluated not only from the surgeon’s point of view by considering the traditional anatomical and hearing outcome, but also from the patient’s perspective by analysing the postoperative QoL. The effects on the QoL of revision CWD with mastoid obliteration have been rarely evaluated so far. Three studies have used the Glasgow Benefit Inventory (GBI) questionnaire, reporting an average postoperative improvement of 29,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> 31<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and 27.3 points,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> respectively. However, this questionnaire was designed to measure health status in terms of social, psychological, and physical perceptions and cannot evaluate the specific aspects of COM.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Two disease-specific questionnaires were also used to investigate the global benefits of secondary mastoid obliteration, the Chronic Otitis Media Benefit Inventory (COMBI)<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and the Zurich Chronic Middle Ear Inventory,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> showing a postoperative improvement in the QoL of an average of 24.5 and 14 points, respectively. The COMQ-12 has been already used to evaluate the QoL after primary obliterative CWD<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> but, to the best of our knowledge, this is the first study that used it after revision mastoidectomy with mastoid obliteration so far. Demir et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> used the COMQ-12 to evaluate the QoL of patients affected by chronic otitis media and showed that cholesteatoma patients reported the poorest QoL with an average score of 45.95. Baetens et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> evaluated the QoL after bony obliteration tympanoplasty for cholesteatoma, finding a post-operative COMQ-12 improvement from 24.92 to 9.35. In the present series secondary obliteration determined a similar QoL to primary obliteration (10.5 vs. 9.1, p-value 0.210) and the average post-operative COMQ-12 scores were comparable to those reported by Baetens et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>. Although the total scores were not different, patients submitted to revision surgery showed significant higher scores in terms of complaint of dizziness (question 6: 0.8 vs. 0.5, p-value 0.019), fear of water contact (question 9: 1 vs. 0.8, p-value 0.007), need to see the GP (question 10: 0.6 vs. 0.2, p-value <0.001) and to take medicines (question 11: 0.2 vs. 0.1, p-value 0.018). It should be however noted that the average score for each item was lower than 1, revealing the scarce clinical relevance of these findings if weighted to the maximum score of 5 points for each question.A sub-analysis performed within the revision group showed that the technique employed at the primary surgery affected the post-revision QoL. In particular, patients previously operated by CWD reported significant higher average scores at questions 3 and 4 of the COMQ-12, that evaluate the hearing comfort in quiet and noisy conditions (question 3: 2.2 vs. 1, p-value 0.008; question 4: 2.6 vs. 1.3, p-value 0.003) and at question 6, that refers to the presence of dizziness or feeling “off balance” (1.3 vs. 0.5, p-value 0.049). We consider that the altered middle ear and mastoid anatomy together with the extent of mastoid obliteration are responsible for these findings. Revision tympanoplasty in an open cavity represents a challenge for the ear surgeon since the tympano-ossicular structures are often missing and the access to bone dust is limited for the previous mastoidectomy as well as the presence of mastoid granulations and inflamed mucosa. A limited mastoid obliteration inevitably results in a more difficult conventional hearing rehabilitation with a consequent greater patient-perceived hearing discomfort<a class="elsevierStyleCrossRef" href="#bib0125">25</a> and in caloric-induced vertigo. In these cases, the use of other biologic or synthetic materials such as conchal cartilage or hydroxyapatite together with bone paste may help reduce the cavity size and protect the labyrinth from thermal stimulation.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>This study has several limitations such as the retrospective nature of the data collection, the limited size of the sample, the variability of the follow-up between the two groups and the unavailability of preoperative COMQ-12 scores; however, despite these drawbacks it represents a unique perspective on the debated subject of secondary mastoid obliteration though the widely validated COMQ-12 questionnaire.ConclusionRevision CWD with mastoid obliteration has shown similar postoperative results to those obtained after primary CWD with obliteration, not only in terms of the traditional anatomical and functional outcome but also regarding the QoL. Besides, the technique performed at primary surgery has been demonstrated to affect the post-revision QoL. In fact, patients primarily treated by CWD without obliteration presented a poorer postoperative QoL, even after secondary obliteration, compared to those previously operated by CWU, mainly because of hearing and balance problems.Disclosure of interestThis work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.The authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2006649" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1719297" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2006650" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1719298" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data collection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical techniques" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Quality of life assessment" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Study design and statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Primary vs. revision CWD with obliteration" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Revision mastoidectomy after CWU vs. revision mastoidectomy after CWD" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Disclosure of interest" ] 10 => array:2 [ "identificador" => "xack701008" "titulo" => "Acknowledgment" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-10-25" "fechaAceptado" => "2023-02-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1719297" "palabras" => array:5 [ 0 => "Revision mastoidectomy" 1 => "Mastoid obliteration" 2 => "Cholesteatoma" 3 => "Quality of life" 4 => "COMQ-12" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1719298" "palabras" => array:5 [ 0 => "Mastoidectomia de revisión" 1 => "Obliteración mastoidea" 2 => "Colesteatoma" 3 => "Calidad de la vida" 4 => "COMQ-12" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "AimsTo evaluate the postoperative quality of life (QoL) after revision canal wall down mastoidectomy with mastoid obliteration (rCWD). Material and methodsA retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019. A control group including all patients treated by primary canal wall down with mastoid obliteration (pCWD) for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL, assessed by the COMQ-12. ResultsThe rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively. No significant difference was found in terms of QoL between the two groups. An intra-group analysis among rCWD patients, showed that patients treated by canal wall down (CWD) at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up (CWU), specifically in the hearing and balance domains of the questionnaire. ConclusionsRevision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration. Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU, even after revision surgery." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aims" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar la calidad de la vida (CdV) post-operatoria después de mastoidectomia de revisión con obliteración mastoidea y timpanoplastia abierta. Materiales y métodosHa sido efectuada una análisis retrospectiva in pacientes afectados por colesteatoma y tratados con mastoidectomia de revision con obliteración mastoidea entre el 2016 y el 2019. Pacientes afectados por colesteatoma y tratados con timpanoplastia abierta primaria con obliteración mastoidea entre el 2009 y el 2014 representan el grupo de control. La CdV post-operatoria ha sido analizada con el cuestionario COMQ-12. ResultadosEl grupo de estudio y el grupo control cuentan respectivamente 38 y 78 pacientes con un seguimiento medio de 30 y 62 meses. La CdV no era significativamente diferente entre los dos grupos. Una sub-análisis en el grupo de estudio ha demostrado que la CdV era significativamente peor en pacientes primitivamente tratados con timpanoplastia abierta en comparación con pacientes primitivamente tratados con timpanoplastia serrada, en particular en los dominios de la audición y del equilibrio. ConclusionesLa CdV obtenida después de la obliteración mastoidea de revisión es comparable a aquella obtenida con timpanoplastia abierta primaria con obliteración mastoidea. Los pacientes sometidos a cirugía de revisión que habían sido tratados con timpanoplastia abierta primaria presentan una CdV peor de los pacientes precedentemente tratados por timpanoplastia cerrada en los dominios de la audición y del equilibrio." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CWD, canal wall down tympanoplasty." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Primary CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Revision CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=78 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N=38 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age in years (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.25±19.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.05±19.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex (male/female ratio) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45/33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20/18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Side (right/left ratio) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38/40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="7" align="left" valign="middle">Labyrinthine fistula N (%)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="middle">0.31</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 1:6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 1:3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 2:3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 2:1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 3:5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 3:1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 4:2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 4:1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 5:1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 5:0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 6:0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade 6:0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dehiscent facial nerve N (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intact stapes N (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 (65.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (68.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ossicular chain reconstruction completed N (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (75.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (73.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332386.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographics and intraoperative findings in primary and revision CWD with obliteration." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CWD, canal wall down tympanoplasty; CWU, canal wall up tympanoplasty; PTAAC, air conduction pure tone average; PTABC, bone conduction pure tone average; ABG, air-bone gap; NS, not significant; μ±SD: mean±standard deviation.Bold: statistically significant results (p<0.05)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWU \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preop. PTAAC in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.8±21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.6±17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.151 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.9±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.9±19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.119 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preop. PTABC in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.9±13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.3±18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.658 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.8±15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.3±20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preop. ABG in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.9±12.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3±13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.043 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.1±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.5±17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.626 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postop. PTAAC in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.5±24.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.6±21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.219 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.1±22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.5±21.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.394 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postop. PTABC in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6±18.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8±13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.905 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.6±15.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.6±21.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.257 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postop. ABG in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.2±14.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.7±13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.046 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.5±10.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.8±17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.707 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ABG Gain in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9±12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.5±13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.671 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.6±13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.568 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delta BC in dB (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.6±14.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.5±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.372 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.8±14.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3±12.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.922 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332383.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of hearing results between primary and revision CWD with obliteration (left side) and between revision mastoidectomy after CWU and revision mastoidectomy after CWD (right side)." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CWU, canal wall up tympanoplasty; CWD, canal wall down tympanoplasty; μ±SD: mean±standard deviation.Bold: statistically significant results (p<0.05)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD with obliteration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWU \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q1-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27±0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27±0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.581 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26±0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28±0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.632 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q2-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.19±0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27±0.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.190 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26±0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28±0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.632 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q3-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.46±1.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.4±1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.809 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1±0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.07±0.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q4-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.58±1.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.81±1.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.35±0.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.57±1.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q5-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18±0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29±0.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26±0.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.35±0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.632 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q6-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51±1.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81±1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52±0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.28±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q7-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.78±1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.03±1.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.084 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.78±0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.43±1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.094 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q8-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.06±1.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86±1.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.178 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61±0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.28±1.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.115 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q9-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77±1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1±1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91±0.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.14±1.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.610 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q10-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18±0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.57±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52±0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.64±0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.610 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q11-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1±0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24±0.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26±0.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21±0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.817 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">q12-COMQ-12 (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.97±1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.89±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.966 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.65±1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.28±1.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.094 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COMQ-12 Tot (μ±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.1±7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.46±9.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.39±6.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.86±6.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332384.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of postoperative COMQ-12 scores between primary and revision CWD with obliteration (left side) and between revision mastoidectomy after CWU and revision mastoidectomy after CWD (right side)." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reasons for revision \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWU \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent cholesteatoma (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Residual cholesteatoma (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperplastic otitis (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent discharge (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent vertigo (N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3332385.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Reasons for revision surgery after CWU or CWD." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The disease recurrence rate after the canal wall up or canal wall down technique in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.G. 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Quality of life after revision mastoidectomy with mastoid obliteration

Calidad de la vida después mastoidectomia de revisión con obliteración mastoidea

Vito Pontillo

Corresponding author

pontillovito@gmail.com

Corresponding author at: Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.

, Sabino Ciprelli, Rossella Grillo, Nicola Quaranta

Otolaryngology Unit, Department of DiBraiN, University of Bari, Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Canal wall up &#40;CWU&#41; and canal wall down &#40;CWD&#41; tympano-mastoidectomies are the main surgical approaches currently in use for the treatment of middle ear and mastoid cholesteatoma&#46; Both techniques present several benefits and drawbacks and the debate on the best surgical technique is still ongoing&#46; CWD offers the advantage of a lower risk of recurrence compared to CWU&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but the need for periodic cleanings and aspirations&#44; the recurrence of infections with malodorous drainage&#44; the inability to wear conventional hearing aids and the exposure to caloric-effect vertigo can seriously affect the patients&#8217; quality of life &#40;QoL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Mastoid obliteration has been proposed with the aim of reducing the cavity size&#44; thus minimizing these major issues and decreasing at the same time the risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Obliterative techniques have been broadly criticized for their possible negative implications in the surveillance of eventual recurrence&#44; but have gained increasing popularity in the last few years&#44; after the development of diffusion-weighted magnetic resonance &#40;MR&#41; techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Revision tympano-mastoidectomy is indicated in case of relapse of cholesteatoma or troublesome mastoid cavity&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In these circumstances&#44; mastoid obliteration has been proposed as an effective technique&#46; Although several authors have reported on the effects of secondary obliteration on the traditional functional and anatomical outcomes&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;9</span></a> its impact on the postoperative QoL has been rarely evaluated so far&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main aim of the present study was to evaluate the postoperative QoL in a group of patients who had undergone revision mastoidectomy with mastoid obliteration&#59; in addition&#44; the role of the surgical technique performed at primary surgery &#40;CWU vs&#46; CWD&#41; was evaluated&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data collection</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective chart analysis was performed including all patients who underwent a revision CWD with mastoid obliteration in our department between January 2016 and December 2019&#46; All patients had been previously operated for cholesteatoma by CWU or CWD without obliteration and had developed recurrence or troublesome mastoid cavity&#46; A control group was selected in order to have a term of comparison&#44; by including all the patients who underwent primary CWD with mastoid obliteration for cholesteatoma in the same department between January 2009 and December 2014&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">All patients had undergone a complete preoperative assessment&#44; including otoscopy under microscope magnification&#44; pure tone audiometry&#44; high-resolution computed tomography &#40;CT&#41; of the temporal bone&#46; MR imaging is not routinely performed in our centre&#44; but limited to cases with intracranial complications or suspected meningocele&#46; The preoperative hearing function and symptoms&#44; the type of surgery and the intra-operative findings&#44; together with the postoperative serial follow-up findings and hearing thresholds were collected from medical records and integrated in an electronic database&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pure-tone average &#40;PTA&#41; values were calculated as the mean of 0&#46;5&#44; 1&#44; 2&#44; and 4<span class="elsevierStyleHsp" style=""></span>kHz thresholds&#44; while Air-Bone Gap &#40;ABG&#41; as the difference between air conduction PTA &#40;PTA<span class="elsevierStyleInf">AC</span>&#41; and bone conduction PTA &#40;PTA<span class="elsevierStyleInf">BC</span>&#41; obtained at each evaluation&#46; Delta-BC was calculated as the difference between the postoperative and preoperative average BC thresholds at 1&#44; 2 and 4<span class="elsevierStyleHsp" style=""></span>kHz&#44; as the possible expression of a sensorineural iatrogenic damage&#46; ABG gain was calculated as the difference between preoperative and postoperative ABG&#46; All data were presented in accordance with the recommendations from the Hearing Committee of the American Academy of Otolaryngology&#8211;Head and Neck Surgery for the evaluation of conductive hearing loss&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical techniques</span><p id="par0035" class="elsevierStylePara elsevierViewall">A detailed description of the surgical technique of CWD with primary obliteration has been published previously&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In brief&#44; after mastoidectomy and antrostomy&#44; the posterior-superior wall of the bony external auditory canal is removed and lowered to the level of the facial nerve&#44; and the anterior epitympanum is exteriorized&#46; An anterior and inferior canaloplasty is performed and the borders of the mastoidectomy are smoothed&#46; Once the cholesteatoma is removed&#44; the tympanic membrane is reconstructed with a large piece of fascia and the mastoid cavity filled with triangles of bone paste made of the previously harvested bone dust from the cortical mastoidectomy&#44; blood&#44; and fibrin glue&#46; The bone paste is then covered with fascia or bovine pericardium &#40;Lyoplant&#59; B&#46; Braun Melsungen AG&#44; Melsungen&#44; Germany&#41; to prevent contact with the skin&#46; An adequate meatoplasty is performed&#44; and the cavity is packed with gelatine sponge&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Revision mastoidectomy in patients previously operated by CWU requires the removal of the posterior canal wall and the removal of the recurrent disease when present&#46; The cavity is then regularized by lowering the posterior bone to the level of the facial nerve and drilling the epitympanic bone&#44; the tympanic membrane reconstructed&#44; and the mastoid cavity partially obliterated with bone paste&#46; Meatoplasty is performed in all cases&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In case of previous CWD or radical mastoidectomy&#44; the revision surgery requires the correction of the anatomical defects&#44; such as an incomplete drilling over the facial nerve &#40;high facial &#8220;ridge&#8221;&#41; or an irregular mastoid cavity&#44; and the removal of pathological tissue&#44; as suggested by Bhatia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Then&#44; the tympanic membrane and middle ear space are reconstructed&#44; and the mastoid cavity partially obliterated with bone paste&#46; Revision meatoplasty should be performed when needed&#46; Staging is planned intra-operatively depending on the status of the middle ear mucosa or the location of cholesteatoma&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Quality of life assessment</span><p id="par0050" class="elsevierStylePara elsevierViewall">The Chronic Otitis Media Questionnaire 12 &#40;COMQ-12&#41;&#44; proposed by Phillips et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> translated in different languages including Italian<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and validated by a multicentric assessment from eight different countries<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> was used to evaluate the QoL&#46; It is a 12-item questionnaire&#44; divided in four different categories&#58; severity of symptoms&#44; specific impact on work and lifestyle&#44; impact on the health service&#44; and general impact on the patient&#46; Based on the degree of inconvenience or frequency of symptoms&#44; each question is scored on a six-point scale from 0 &#40;no impact or sporadic occurrence&#41; to 5 &#40;most severe impact or daily occurrence&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Due to SARS-CoV2 pandemic restrictions&#44; all patients were contacted by telephone and received appropriate and comprehensible information about the study&#46; An online or printed template of the previously validated Italian version of the COMQ-12 questionnaire<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> was addressed&#44; together with a written agreement form&#44; to those who had given their oral consent by telephone&#46; Replies and signed informed consent were received by the same modalities&#46; Thus&#44; the overall COMQ-12 score was calculated for each case&#44; by adding the single answer scores&#46; The study was approved by the local Ethics Committee &#40;PROT 4799&#47;2019&#41; and was carried out in accordance with the Declaration of Helsinki&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Study design and statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">In order to evaluate the role of secondary mastoid obliteration&#44; revision cases were compared with primary CWD with mastoid obliteration in terms of QoL and in terms of the anatomical and hearing outcomes&#46; In addition&#44; an intra-group comparison was performed within the revision cohort between two subgroups&#44; based on the technique used at primary surgery &#40;CWU vs&#46; CWD&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Categorical or dichotomous variables were expressed as absolute number and percentage &#40;N&#44; &#37;&#41;&#46; Continuous variables were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#46; Fisher&#8217;s exact test was used to compare categorical variables&#44; Mann&#8211;Whitney test to compare continuous variables&#46; A p-value &#60;0&#46;05 was considered as statistically significant&#46; The software IBM SPSS Statistics &#40;Version 26&#41; was used for statistical analysis&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Primary vs&#46; revision CWD with obliteration</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study group consisted of 38 patients &#40;20 males and 18 females&#41; with a mean age of 42&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;41 years &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; at the time of the revision surgery&#46; Average clinical postoperative follow-up was 29&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6 months &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#44; while the COMQ-12 was recorded on average 37&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3 months &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; after the surgery&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The control group consisted of 78 &#40;45 males and 33 females&#41; patients with a mean age of 46&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;41 years &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#46; Average clinical postoperative follow-up was 61&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32 months &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#44; while the COMQ-12 was recorded on average 86&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#46;5 months &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; after the surgery&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> reports the demographics of the two groups as well as the main intraoperative findings&#46; Statistical analysis showed that the two groups were not significantly different in terms of age&#44; sex and affected side&#44; as well as in terms of intra-operative findings and in the rate of patients that completed the reconstructive time of surgery&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the primary CWD group residual cholesteatoma occurred in 5 cases &#40;6&#46;4&#37;&#41; and long-term anatomical complications&#44; such as tympanic membrane retraction or lateralisation&#44; granulations&#44; or serous otitis media&#44; in 10 cases &#40;12&#46;8&#37;&#41;&#46; In the revision CWD group no cases of residual or recurrent cholesteatoma were recorded&#46; In 2 cases &#40;5&#46;3&#37;&#41; a dehiscence of the tympanic membrane was evident at last clinical follow-up&#44; in the remaining cases a dry and clean cavity with an intact TM was found&#46; No cases of necrosis&#44; infection or extrusion of the obliterated cavity were recorded in the two groups&#46; Statistical analysis did not show a statistical difference between the two groups in terms of anatomical complications &#40;p-value &#62;0&#46;05&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> &#40;left side&#41; reports pre- and post-operative hearing results in the two groups&#46; Both pre- and post-operative thresholds did not significantly differ between the primary and revision CWD with obliteration&#44; except for a trend towards significance for the higher pre- &#40;33&#46;3 vs&#46; 27&#46;9&#44; p-value 0&#46;043&#41; and post-operative ABGs &#40;29&#46;7 vs&#46; 25&#46;2&#44; p-value 0&#46;046&#41; in the revision group compared to the primary CWD group&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> &#40;left side&#41; reports the COMQ-12 scores in the study group and control group&#46; The total COMQ-12 score was not significantly different between the two groups &#40;9&#46;1 vs&#46; 10&#46;46&#41;&#44; but revision patients reported significantly higher scores at Question 6 &#40;<span class="elsevierStyleItalic">&#8216;Dizziness or feeling of off-balance&#8217;</span>&#44; 0&#46;8 vs&#46; 0&#46;5&#44; p-value 0&#46;019&#41;&#44; Question 9 &#40;<span class="elsevierStyleItalic">&#8216;How often have you been fearful of washing or having shower causing an ear infection&#63;&#8217;</span>&#44; 1 vs&#46; 0&#46;8&#44; p-value 0&#46;007&#41;&#44; Question 10 &#40;<span class="elsevierStyleItalic">&#8216;How often have you been to see your GP about your ear problems&#63;&#8217;</span>&#44; 0&#46;6 vs&#46; 0&#46;2&#44; p-value &#60;0&#46;001&#41; and Question 11 &#40;<span class="elsevierStyleItalic">&#8216;How often do you need to take medicines for your ear problem&#63;&#8217;</span>&#44; 0&#46;2 vs&#46; 0&#46;1&#44; p-value 0&#46;018&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Revision mastoidectomy after CWU vs&#46; revision mastoidectomy after CWD</span><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> reports the reason for revision surgery according to the primary surgical technique&#46; Among patients who underwent revision surgery&#44; 23 had been initially treated by CWU and 15 by CWD&#44; including 11 cases of radical mastoidectomy&#46; Reasons for revision after CWU were recurrent cholesteatoma in 18 cases &#40;78&#37;&#41; and residual cholesteatoma in 3 cases &#40;13&#37;&#41;&#44; while a hyperplastic otitis media was found in 2 cases &#40;9&#37;&#41;&#46; Reasons for revision after CWD were troublesome mastoid cavity in 11 cases &#40;73&#37;&#41; and recurrent cholesteatoma in 4 &#40;27&#37;&#41;&#46; The most frequent cavity problems were frequent debris accumulation with recurrent discharge in 6 cases &#40;54&#46;5&#37;&#41; and recurrent vertigo in 5 cases &#40;45&#46;5&#37;&#41;&#46; In no case the mastoid was found to be previously obliterated&#46; Statistical analysis showed that recurrent cholesteatoma was the reason for revision surgery more frequently in patients who had undergone CWU as primary intervention&#44; compared to those who had undergone primary CWD &#40;78&#46;3&#37; vs&#46; 26&#46;7&#37;&#44; p-value 0&#46;005&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> &#40;right side&#41; reports pre- and post-revision hearing results in the two subgroups&#46; Preoperative PTA<span class="elsevierStyleInf">BC</span> was significantly higher in patients previously submitted to CWD compared to those who had undergone a CWU &#40;27&#46;3 vs&#46; 19&#46;8&#44; p-value 0&#46;035&#41;&#44; while all other values were not significantly different between the two subgroups&#46; Despite the lack of statistical significance&#44; the postoperative PTA<span class="elsevierStyleInf">AC</span> &#40;60&#46;5 vs&#46; 55&#46;1&#41; and PTA<span class="elsevierStyleInf">BC</span> &#40;31&#46;6 vs&#46; 24&#46;6&#41; were higher in the CWD subgroup&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The postoperative COMQ-12 scores in the two subgroups are reported in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> &#40;right side&#41;&#46; After revision CWD with obliteration&#44; patients previously operated by CWD presented a significantly worse overall COMQ-12 score compared to patients initially treated by CWU &#40;13&#46;9 vs&#46; 8&#46;4&#44; p-value 0&#46;013&#41; and also significantly higher subscores at Question 3 &#40;<span class="elsevierStyleItalic">&#8216;Hearing problems at home&#8217;</span>&#44; 2&#46;1 vs&#46; 1&#44; p-value 0&#46;008&#41;&#44; Question 4 &#40;<span class="elsevierStyleItalic">&#8216;Hearing problems when talking to people in groups or there are noisy surroundings&#8217;</span>&#44; 2&#46;6 vs&#46; 1&#46;3&#44; p-value 0&#46;003&#41; and Question 6 &#40;<span class="elsevierStyleItalic">&#8216;Dizziness or feeling off-balance&#8217;</span>&#44; 1&#46;3 vs&#46; 0&#46;5&#44; p-value 0&#46;049&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Surgical management of cholesteatoma is one of the most challenging domains for an otologist&#46; Several techniques have been proposed&#44; each one with its own advantages and disadvantages&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> all sharing the common aims of the complete removal of the matrix&#44; the reconstruction of a a dry and safe middle ear and the restoration of a socially acceptable hearing level&#46; These three traditional goals of cholesteatoma surgery&#44; when achieved&#44; result in a veritable benefit in patients&#8217; QoL&#46; Revision surgery retains the same three goals but can be even more challenging since the surgeon must deal with an altered anatomy and distorted surgical landmarks&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Anatomical complications&#44; such as residual and recurrent disease or troublesome mastoid cavities&#44; represent the most common indications for revision surgery&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The advantages of primary mastoid obliteration have already been discussed in a previous work&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In the present study the results of revision mastoidectomy with mastoid obliteration were evaluated not only from the surgeon&#8217;s point of view by considering the traditional anatomical and hearing outcome&#44; but also from the patient&#8217;s perspective by analysing the postoperative QoL&#46; The effects on the QoL of revision CWD with mastoid obliteration have been rarely evaluated so far&#46; Three studies have used the Glasgow Benefit Inventory &#40;GBI&#41; questionnaire&#44; reporting an average postoperative improvement of 29&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> 31<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and 27&#46;3 points&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> respectively&#46; However&#44; this questionnaire was designed to measure health status in terms of social&#44; psychological&#44; and physical perceptions and cannot evaluate the specific aspects of COM&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Two disease-specific questionnaires were also used to investigate the global benefits of secondary mastoid obliteration&#44; the Chronic Otitis Media Benefit Inventory &#40;COMBI&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and the Zurich Chronic Middle Ear Inventory&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> showing a postoperative improvement in the QoL of an average of 24&#46;5 and 14 points&#44; respectively&#46; The COMQ-12 has been already used to evaluate the QoL after primary obliterative CWD<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> but&#44; to the best of our knowledge&#44; this is the first study that used it after revision mastoidectomy with mastoid obliteration so far&#46; Demir et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> used the COMQ-12 to evaluate the QoL of patients affected by chronic otitis media and showed that cholesteatoma patients reported the poorest QoL with an average score of 45&#46;95&#46; Baetens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> evaluated the QoL after bony obliteration tympanoplasty for cholesteatoma&#44; finding a post-operative COMQ-12 improvement from 24&#46;92 to 9&#46;35&#46; In the present series secondary obliteration determined a similar QoL to primary obliteration &#40;10&#46;5 vs&#46; 9&#46;1&#44; p-value 0&#46;210&#41; and the average post-operative COMQ-12 scores were comparable to those reported by Baetens et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46; Although the total scores were not different&#44; patients submitted to revision surgery showed significant higher scores in terms of complaint of dizziness &#40;question 6&#58; 0&#46;8 vs&#46; 0&#46;5&#44; p-value 0&#46;019&#41;&#44; fear of water contact &#40;question 9&#58; 1 vs&#46; 0&#46;8&#44; p-value 0&#46;007&#41;&#44; need to see the GP &#40;question 10&#58; 0&#46;6 vs&#46; 0&#46;2&#44; p-value &#60;0&#46;001&#41; and to take medicines &#40;question 11&#58; 0&#46;2 vs&#46; 0&#46;1&#44; p-value 0&#46;018&#41;&#46; It should be however noted that the average score for each item was lower than 1&#44; revealing the scarce clinical relevance of these findings if weighted to the maximum score of 5 points for each question&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A sub-analysis performed within the revision group showed that the technique employed at the primary surgery affected the post-revision QoL&#46; In particular&#44; patients previously operated by CWD reported significant higher average scores at questions 3 and 4 of the COMQ-12&#44; that evaluate the hearing comfort in quiet and noisy conditions &#40;question 3&#58; 2&#46;2 vs&#46; 1&#44; p-value 0&#46;008&#59; question 4&#58; 2&#46;6 vs&#46; 1&#46;3&#44; p-value 0&#46;003&#41; and at question 6&#44; that refers to the presence of dizziness or feeling &#8220;off balance&#8221; &#40;1&#46;3 vs&#46; 0&#46;5&#44; p-value 0&#46;049&#41;&#46; We consider that the altered middle ear and mastoid anatomy together with the extent of mastoid obliteration are responsible for these findings&#46; Revision tympanoplasty in an open cavity represents a challenge for the ear surgeon since the tympano-ossicular structures are often missing and the access to bone dust is limited for the previous mastoidectomy as well as the presence of mastoid granulations and inflamed mucosa&#46; A limited mastoid obliteration inevitably results in a more difficult conventional hearing rehabilitation with a consequent greater patient-perceived hearing discomfort<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and in caloric-induced vertigo&#46; In these cases&#44; the use of other biologic or synthetic materials such as conchal cartilage or hydroxyapatite together with bone paste may help reduce the cavity size and protect the labyrinth from thermal stimulation&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">This study has several limitations such as the retrospective nature of the data collection&#44; the limited size of the sample&#44; the variability of the follow-up between the two groups and the unavailability of preoperative COMQ-12 scores&#59; however&#44; despite these drawbacks it represents a unique perspective on the debated subject of secondary mastoid obliteration though the widely validated COMQ-12 questionnaire&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">Revision CWD with mastoid obliteration has shown similar postoperative results to those obtained after primary CWD with obliteration&#44; not only in terms of the traditional anatomical and functional outcome but also regarding the QoL&#46; Besides&#44; the technique performed at primary surgery has been demonstrated to affect the post-revision QoL&#46; In fact&#44; patients primarily treated by CWD without obliteration presented a poorer postoperative QoL&#44; even after secondary obliteration&#44; compared to those previously operated by CWU&#44; mainly because of hearing and balance problems&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Disclosure of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">This work received no specific grant from any funding agency in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Materiales y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
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        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1719298"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Data collection"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Surgical techniques"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Quality of life assessment"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Study design and statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Primary vs&#46; revision CWD with obliteration"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Revision mastoidectomy after CWU vs&#46; revision mastoidectomy after CWD"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Disclosure of interest"
        ]
        10 => array:2 [
          "identificador" => "xack701008"
          "titulo" => "Acknowledgment"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-10-25"
    "fechaAceptado" => "2023-02-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1719297"
          "palabras" => array:5 [
            0 => "Revision mastoidectomy"
            1 => "Mastoid obliteration"
            2 => "Cholesteatoma"
            3 => "Quality of life"
            4 => "COMQ-12"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1719298"
          "palabras" => array:5 [
            0 => "Mastoidectomia de revisi&#243;n"
            1 => "Obliteraci&#243;n mastoidea"
            2 => "Colesteatoma"
            3 => "Calidad de la vida"
            4 => "COMQ-12"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aims</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">To evaluate the postoperative quality of life &#40;QoL&#41; after revision canal wall down mastoidectomy with mastoid obliteration &#40;rCWD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis was conducted on patients treated by rCWD for cholesteatoma between 2016 and 2019&#46; A control group including all patients treated by primary canal wall down with mastoid obliteration &#40;pCWD&#41; for cholesteatoma between 2009 and 2014 was used for the comparison of the postoperative QoL&#44; assessed by the COMQ-12&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The rCWD and pCWD groups respectively counted 38 and 78 patients with an average follow-up of 30 and 62 months respectively&#46; No significant difference was found in terms of QoL between the two groups&#46; An intra-group analysis among rCWD patients&#44; showed that patients treated by canal wall down &#40;CWD&#41; at the primary surgery had a significantly worse post-revision QoL compared to those initially treated by canal wall up &#40;CWU&#41;&#44; specifically in the hearing and balance domains of the questionnaire&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Revision mastoid obliteration leads to similar QoL results to those obtained after primary CWD with obliteration&#46; Patients who had undergone a CWD as primary surgery complain worse hearing and balance problems compared to those primarily submitted to CWU&#44; even after revision surgery&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Aims"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Evaluar la calidad de la vida &#40;CdV&#41; post-operatoria despu&#233;s de mastoidectomia de revisi&#243;n con obliteraci&#243;n mastoidea y timpanoplastia abierta&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Ha sido efectuada una an&#225;lisis retrospectiva in pacientes afectados por colesteatoma y tratados con mastoidectomia de revision con obliteraci&#243;n mastoidea entre el 2016 y el 2019&#46; Pacientes afectados por colesteatoma y tratados con timpanoplastia abierta primaria con obliteraci&#243;n mastoidea entre el 2009 y el 2014 representan el grupo de control&#46; La CdV post-operatoria ha sido analizada con el cuestionario COMQ-12&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El grupo de estudio y el grupo control cuentan respectivamente 38 y 78 pacientes con un seguimiento medio de 30 y 62 meses&#46; La CdV no era significativamente diferente entre los dos grupos&#46; Una sub-an&#225;lisis en el grupo de estudio ha demostrado que la CdV era significativamente peor en pacientes primitivamente tratados con timpanoplastia abierta en comparaci&#243;n con pacientes primitivamente tratados con timpanoplastia serrada&#44; en particular en los dominios de la audici&#243;n y del equilibrio&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">La CdV obtenida despu&#233;s de la obliteraci&#243;n mastoidea de revisi&#243;n es comparable a aquella obtenida con timpanoplastia abierta primaria con obliteraci&#243;n mastoidea&#46; Los pacientes sometidos a cirug&#237;a de revisi&#243;n que hab&#237;an sido tratados con timpanoplastia abierta primaria presentan una CdV peor de los pacientes precedentemente tratados por timpanoplastia cerrada en los dominios de la audici&#243;n y del equilibrio&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0065"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CWD&#44; canal wall down tympanoplasty&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Primary CWD with obliteration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Revision CWD with obliteration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">p-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age in years &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;25<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;05<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sex &#40;male&#47;female ratio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#47;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#47;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Side &#40;right&#47;left ratio&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#47;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="7" align="left" valign="middle">Labyrinthine fistula N &#40;&#37;&#41;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;15&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="7" align="left" valign="middle">0&#46;31</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 1&#58;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 1&#58;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 2&#58;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 2&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 3&#58;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 3&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 4&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 4&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 5&#58;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 5&#58;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 6&#58;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Grade 6&#58;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dehiscent facial nerve N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intact stapes N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;65&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;68&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ossicular chain reconstruction completed N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;75&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;73&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CWD&#44; canal wall down tympanoplasty&#59; CWU&#44; canal wall up tympanoplasty&#59; PTA<span class="elsevierStyleInf">AC</span>&#44; air conduction pure tone average&#59; PTA<span class="elsevierStyleInf">BC</span>&#44; bone conduction pure tone average&#59; ABG&#44; air-bone gap&#59; NS&#44; not significant&#59; &#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#58; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bold&#58; statistically significant results &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Primary CWD with obliteration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD with obliteration&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Revision CWD after CWD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Preop&#46; PTA<span class="elsevierStyleInf">AC</span></span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Preop&#46; PTA<span class="elsevierStyleInf">BC</span></span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;658&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;035</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Preop&#46; ABG</span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;043</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;626&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Postop&#46; PTA<span class="elsevierStyleInf">AC</span></span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;394&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Postop&#46; PTA<span class="elsevierStyleInf">BC</span></span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;257&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Postop&#46; ABG</span> in dB &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;046</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Comparison of hearing results between primary and revision CWD with obliteration &#40;left side&#41; and between revision mastoidectomy after CWU and revision mastoidectomy after CWD &#40;right side&#41;&#46;</p>"
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                  \t\t\t\t">8&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;18&nbsp;\t\t\t\t\t\t\n
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                            0 => "S&#46; Patil"
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Article information

ISSN: 00016519
Original language: English

DOI:10.1016/j.otorri.2023.02.001

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