09-12, 11:45–12:45 (Europe/Istanbul), Otology 4
“The Modern Day Management of Chronic Otitis Media/Cholesteatoma: Combining European and American Perspectives Over a Half-Century of Combined Experience”
Alexandre Karkas, MD, PhD <sup>2</sup> , <u>Ravi N. Samy, MD, FACS</u> <sup>1</sup>
<sup>1</sup>LVHN/Jefferson Health, Sidney Kimmel College of Medicine, Thomas Jefferson University, Professor and Chief, OHNS
<sup>2</sup>Alexandre Karkas, MD, PhD, Professor and Chairman, Dept. of OHNS, University Medical Center of Saint-Etienne
Background & Aim
Modern day management of epidermoid cysts/cholesteatomas/chronic otitis media is still a challenge and a conundrum. While the principles never change (i.e., making an ear clean, safe, and dry), adapting new technologies and treatment modalities should reduce the morbidity of this disease and improve the potential for rehabilitation (e.g., auditory, vestibular, and facial).
Material & Methods
The 2 presenting physicians will review their cases over their prior 25 years each (between fellowship and attending level practice)
Results
The physicians have used a variety of approaches to treat their cholesteatomas, including: 1) standard otologic approaches: transmastoid (CWD/CWU/CWR mastoidectomy), transcanal, endaural 2) mastoid obliterations with bone pate/bioactive glass 3) skull base approaches (middle cranial fossa, retrosigmoid, retrolabyrinthine/translabyrinthine). The endoscope has been important to assess for hidden cholesteatomas. MRI DWI images have reduced the need for 2nd looks while monitoring for recurrence. The laser has been useful to eradicate microscopic disease. One presenter is investigating the use of oncolytic virus in animal models for eradication of disease. This will also be discussed. And finally, the utilization of adjunctive techniques and technologies will discuss how to manage any deficits (e.g., hearing, balance, or facial nerve related).
Conclusions
The evolution of the management of COM/cholesteatoma continues unabated. While the progress may be slow, it is steady and shows the promise for a disease that has existed for 1000’s of years of mankind’s history. The case examples show how otolaryngologists can continue to learn and progress in the management of this challenging disease.
Keywords
cholesteatoma, chronic otitis media, laser, endoscopy, mastoid obliteration, microscope, MRI, otologic drill, bone pate, bioactive glass
Additional Info
The presenters (Drs. Ravi N. Samy and Alex Karkas) will include video presentations of their significant and vast experiences.
To educate our general OHNS audience on cutting-edge management and treatment of COM/cholesteatoma.
Alexandre KARKAS, MD, PhD, HDR
Professor and Chairman, Department of Otorhinolaryngology - Head & Neck Surgery
European Board of Otorhinolaryngology - Head & Neck Surgery
Otology - Auditory implants - Skull base surgery – Robotic & endoscopic ear surgery
University Medical Center of Saint-Etienne
Medical School of Jean Monnet University, Saint-Etienne, France
Research Laboratory SAINBIOSE Inserm U1059, Saint-Etienne, France
75 indexed publications as author and coauthor,
11 book chapters as author and coauthor
Dr. Ravi N. Samy is Chief of Otolaryngology-Head and Neck Surgery (OHNS) at LVHN/Jefferson Health in Allentown, PA. Dr. Samy is also Professor of OHNS at Sidney Kimmel Medical College, Thomas Jefferson University. Dr. Samy was born in Madras (Chennai), India, and emigrated to the United States at the age of four. He spent most of his formative years living in Texas, but he moved to Duke University in North Carolina for his undergraduate education. After graduating magna cum laude, he attended the Duke University School of Medicine until finished in 1995. He then completed his residency training at Stanford University School of Medicine, where he developed a love for otology, neurotology, and skull base surgery. Dr. Samy spent two years at the University of Iowa as a Neurotology fellow before moving back to Texas to be an Assistant Professor at the UT-Southwestern Medical Center in Dallas. He then spent 17 years at the University of Cincinnati/Cincinnati Children’s, where he created an ACGME accredited, two-year Neurotology fellowship as well as an International Fellowship in Advanced Otology. He has been at LVHN since March, 2023. His research interests include cochlear and auditory brainstem implantation as well as acoustic neuromas, neurofibromatosis type 2, facial nerve tumors, cholesteatomas, and other diseases and disorders of the lateral skull base. He and his colleague, Dr. Brian Earl, were awarded an NASBS research grant for their oncolytic virus work for the treatment of cholesteatomas and epidermoid cysts of the skull base.