MDT discussion results
All patients participated in a perioperative MDT discussion for the evaluation of the safety and feasibility of surgery, preliminarily prediction of the postoperative effects, and prevention of the occurrence of postoperative complications. The following results were obtained: 1) All primary lesions were completely controlled after comprehensive treatment without signs of residues, recurrence, or metastasis; 2) All patients were classified into three different classes. Five patients of grade (a), whose ORNTB were localized by an intact TM and continuous cortical bone of the posterior and superior walls of the EAC, were accepted for routine CI (Fig. 2a). Two patients of grade (b) with diffuse ORNTB and an intact TM and a continuous cortical bone of the posterior and superior walls of the EAC were subjected to simultaneous extended radical mastoidectomy and CI (Fig. 2b). The other four patients of grade (c) simultaneously underwent subtotal petrosectomy (STP), external auditory canal elimination, mastoid cavity obliteration by fat graft or musculoperiosteal flaps and CI because of their diffuse ORNTB with perforate TM and defects in the posterior and upper walls of the EAC (Fig. 2c); 3) Radiologists diagnosed five patients who had different levels of REP depending on standard MRI and CT. Neurologists and psychiatrists found that four of them had no abnormal neurological symptoms or clinical signs due to REP. It is worth noting that a patient had been diagnosed with REP on the bilateral temporal lobe after epileptic seizures in 2012 and underwent partial radiation lesion resection of the right temporal lobe. Because the epilepsy was well controlled and the patient did not occur any seizure over a year, MDT team did not regard REP as a surgical contraindication. But REP was predicted to probably affect postoperative hearing recovery; 4) According to modified Mallampati scores, anesthesiologists classified four patients into grade IV, characterized by difficult airway passage, thus nasotracheal intubation under fiberoptic bronchoscopy was considered, combined with preparation of emergency measures such as tracheotomy before anesthesia.