Mastoid Surgery Does Not Normalize Tympanometric Middle Ear Pressure in Children With Cholesteatoma
Bibliographic record
Abstract
ABSTRACT Objective To determine whether transcanal surgery without mastoidectomy, canal wall up (CWU), canal wall down (CWD), or CWU mastoid obliteration (MO) surgery for pediatric cholesteatoma has a more favorable effect on middle ear pressure (MEP) homeostasis. Methods Data from children having mastoid surgery for acquired cholesteatoma were collected prospectively. Tympanometric values of MEP were compared after transcanal, CWU, CWD, and MO surgery analyzing (i) a single measure per ear from last clinic visit, and (ii) linear mixed‐effects modeling (LMEM) to control for multiple measures, surgeries, age, and cholesteatoma severity (EAONO‐JOS stage). Results 742 surgeries on 471 ears and 2382 tympanograms were completed. At last visit, (average age 15.6 years [6.0–19.3]), Type a tympanograms were present in 80/173 (46%) of transcanal surgeries, 64/132 (48%) CWU, 15/32 (47%) CWD, and 11/25 (44%) MO (Chi‐square, p = 0.19), but 185/209 (89%) contralateral ears without cholesteatoma (Chi‐square: p = 1.08 × 10 −7 ). Median MEP was −47 daPa (IQR: 133) after transcanal, −65 daPa (IQR: 156) after CWU, −90 daPa (IQR: 151) after CWD, and −31 daPa (IQR: 151) after MO surgery and (Kruskal–Wallis: p = 0.4) but 5 daPa (IQR: 45) in normal contralateral ears (Wilcoxon: p = 7.92 × 10 −13 ). LMEM showed MEP was dependent on age ( p = 6.3 × 10 −7 ) but not type of mastoid surgery ( p = 0.70) or EAONO‐JOS stage ( p = 0.51). Conclusion MEP after surgery for pediatric cholesteatoma is similar after transcanal, CWU, CWD, or MO surgery and remains lower than normal. Hypotheses that propose beneficial effects of these different surgical approaches on MEP homeostasis are not supported, so should not be used to influence choice of surgical approach. Level of Evidence 3.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".