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B-ENT 2016Middle ear damages. The eardrum and middle ear are often exposed to blunt and penetrating trauma, blasts, thermal or caustic injuries. These injuries may result in... (Review)
Review
Middle ear damages. The eardrum and middle ear are often exposed to blunt and penetrating trauma, blasts, thermal or caustic injuries. These injuries may result in tympanic membrane perforation, middle ear haemorrhage, dislocation and fracture of the ossicular chain, perilymphatic fistula and damage to the chorda tympani and/or facial nerve. In case of life-threatening injuries and/or mass casualty incidents, middle ear trauma obviously does not take highest priority. However, middle ear lesions should be suspected and recognized as early as possible. After meticulous history taking, physical examination consists of cranial nerve evaluation, thorough inspection of the outer ear, otoscopy and assessment of hearing and vestibular function. In the majority of cases, traumatic tympanic membrane perforations by penetrating and blunt injuries have a good prognosis with spontaneous resolution. Tympanic membrane perforations from blast trauma, thermal or caustic injuries are less likely to heal spontaneously. Perforations lasting six months after injury warrant surgery. A high resolution CT scan of the temporal bone is required in case of immediate complete facial nerve paralysis and when oval window pathology or perilymphatic fistula is suspected. Early surgical intervention is needed in case of early onset facial nerve paralysis, when there is suspicion of a perilymphatic fistula with persisting or increasing vestibular symptoms or neurosensory hearing loss and in case of vestibular dislocation of the stapes footplate. When ossicular chain damage is suspected, elective tympanoplasty is indicated. As any traumatic tympanic membrane perforation runs the risk of cholesteatoma formation, biannual follow-up during a minimum of two years is recommended.
Topics: Aftercare; Blast Injuries; Ear, Middle; Humans; Otoscopy; Tomography, X-Ray Computed; Tympanic Membrane Perforation; Tympanoplasty; Wounds, Penetrating
PubMed: 29461741
DOI: No ID Found -
Otolaryngologic Clinics of North America Oct 2016The fibrocartilaginous eustachian tube is part of a system of contiguous organs including the nose, palate, rhinopharynx, and middle ear cleft. The middle ear cleft... (Review)
Review
The fibrocartilaginous eustachian tube is part of a system of contiguous organs including the nose, palate, rhinopharynx, and middle ear cleft. The middle ear cleft consists of the tympanic cavity, which includes the bony eustachian tube (protympanum) and the mastoid gas cells system. The tympanic cavity and mastoid gas cells are interconnected and allow gaseous exchange and pressure regulation. The fibrocartilaginous eustachian tube is a complex organ consisting of a dynamic conduit with its mucosa, cartilage, surrounding soft tissue, peritubal muscles (ie, tensor and levator veli palatine, salpingopharyngeus and tensor tympani), and superior bony support (the sphenoid sulcus).
Topics: Argon; Carbon Dioxide; Central Nervous System; Ear, Middle; Eustachian Tube; Humans; Mucous Membrane; Nitrogen; Oxygen; Peripheral Nervous System; Pressure
PubMed: 27468632
DOI: 10.1016/j.otc.2016.05.003 -
The Journal of the Acoustical Society... Apr 2021The mouse is an important animal model for hearing science. However, our knowledge of the relationship between mouse middle-ear (ME) anatomy and function is limited. The...
The mouse is an important animal model for hearing science. However, our knowledge of the relationship between mouse middle-ear (ME) anatomy and function is limited. The ME not only transmits sound to the cochlea in the forward direction, it also transmits otoacoustic emissions generated in the cochlea to the ear canal (EC) in the reverse direction. Due to experimental limitations, a complete characterization of the mouse ME has not been possible. A fully coupled finite-element model of the mouse EC, ME, and cochlea was developed and calibrated against experimental measurements. Impedances of the EC, ME, and cochlea were calculated, alongside pressure transfer functions for the forward, reverse, and round-trip directions. The effects on sound transmission of anatomical changes such as removing the ME cavity, pars flaccida, and mallear orbicular apophysis were also calculated. Surprisingly, below 10 kHz, the ME cavity, eardrum, and stapes annular ligament were found to significantly affect the cochlear input impedance, which is a result of acoustic coupling through the round window. The orbicular apophysis increases the delay of the transmission line formed by the flexible malleus, incus, and stapes, and improves the forward sound-transmission characteristics in the frequency region of 7-30 kHz.
Topics: Acoustic Stimulation; Acoustics; Animals; Cochlea; Ear, Middle; Mice; Round Window, Ear; Sound; Stapes
PubMed: 33940924
DOI: 10.1121/10.0004218 -
Hearing Research Jul 2019
Topics: Animals; Biomedical Research; Diffusion of Innovation; Ear, Middle; Humans; Otolaryngology; Otologic Surgical Procedures
PubMed: 30914231
DOI: 10.1016/j.heares.2019.03.008 -
Otolaryngologic Clinics of North America Feb 2021Middle ear anatomy and physiology is highly complex, yet familiarity is important to perform middle ear surgery and understand surgically relevant ventilation pathways... (Review)
Review
Middle ear anatomy and physiology is highly complex, yet familiarity is important to perform middle ear surgery and understand surgically relevant ventilation pathways of the ear compartments. The middle ear is divided into five subspaces: the mesotympanum, the retrotympanum posteriorly, the epitympanum superiorly, the protympanum anteriorly, and the hypotympanum inferiorly. The Eustachian tube plays a crucial role in maintaining middle ear aeration and atmospheric pressure. There are two independent aeration routes of the epitympanum. Thanks to the advent of the endoscope, this anatomic and physiologic knowledge has allowed one to understand the pathophysiology of ear diseases, improving surgical concepts.
Topics: Ear, Middle; Endoscopy; Humans; Middle Ear Ventilation; Otoscopy; Treatment Outcome
PubMed: 33153736
DOI: 10.1016/j.otc.2020.09.003 -
Neuroimaging Clinics of North America Feb 2019Although not all patients with tinnitus require imaging, patients with tinnitus and asymmetric hearing loss, additional neurologic findings, or pulsatile tinnitus should... (Review)
Review
Although not all patients with tinnitus require imaging, patients with tinnitus and asymmetric hearing loss, additional neurologic findings, or pulsatile tinnitus should be evaluated with an appropriately tailored imaging study. Choice of imaging study should be guided by type of hearing loss and additional physical examination findings, such as middle ear lesion, presence of carotid bruit, or pulsatile tinnitus extinguished by jugular compression.
Topics: Cranial Sinuses; Ear, Middle; Humans; Magnetic Resonance Imaging; Temporal Bone; Tinnitus; Tomography, X-Ray Computed
PubMed: 30466644
DOI: 10.1016/j.nic.2018.09.006 -
Current Allergy and Asthma Reports Sep 2016Recent studies have attempted to identify interactions among the causes of otitis media with effusion (OME). This review discusses the interaction between allergy and... (Review)
Review
PURPOSE OF REVIEW
Recent studies have attempted to identify interactions among the causes of otitis media with effusion (OME). This review discusses the interaction between allergy and infection with regard to host and environmental factors in terms of the development of OME.
RECENT FINDINGS
Protection of the upper airway against microbial invasion requires active interaction between the defense mechanisms of the respiratory epithelium, including innate and adaptive immunity, and mechanical factors. The impairment of these defenses due to allergy and/or increased bacterial resistance may lead to increased susceptibility to infectious organisms in the respiratory tract and middle ear mucosa. Recent genetic studies have provided valuable information about the association of Toll-like receptor signaling variations with clinical phenotypes and the risk of infection in the middle ear. Among the causal factors of OME, allergy not only induces an inflammatory reaction in the middle ear cavity but also facilitates the invasion of infectious pathogens. There is also evidence that allergy can affect the susceptibility of patients to infection of the upper respiratory tract, including the middle ear cavity.
Topics: Child; Ear, Middle; Humans; Hypersensitivity; Otitis Media with Effusion
PubMed: 27544665
DOI: 10.1007/s11882-016-0646-1 -
Current Topics in Developmental Biology 2015The perception of our environment via sensory organs plays a crucial role in survival and evolution. Hearing, one of our most developed senses, depends on the proper... (Review)
Review
The perception of our environment via sensory organs plays a crucial role in survival and evolution. Hearing, one of our most developed senses, depends on the proper function of the auditory system and plays a key role in social communication, integration, and learning ability. The ear is a composite structure, comprised of the external, middle, and inner ear. During development, the ear is formed from the integration of a number of tissues of different embryonic origin, which initiate in distinct areas of the embryo at different time points. Functional connections between the components of the hearing apparatus have to be established and maintained during development and adulthood to allow proper sound submission from the outer to the middle and inner ear. This highly organized and intimate connectivity depends on intricate spatiotemporal signaling between the various tissues that give rise to the structures of the ear. Any alterations in this chain of events can lead to the loss of integration, which can subsequently lead to conductive hearing loss, in case of outer and middle ear defects or sensorineural hearing loss, if inner ear structures are defective. This chapter aims to review the current knowledge concerning the development of the three ear compartments as well as mechanisms and signaling pathways that have been implicated in the coordination and integration process of the ear.
Topics: Animals; Ear; Ear, External; Ear, Middle; Epithelium; Hearing; Humans; Mesoderm; Models, Biological; Morphogenesis
PubMed: 26589927
DOI: 10.1016/bs.ctdb.2015.07.007 -
Acta Oto-laryngologica Feb 2022Ear canal and middle ear tumors are rare and exhibit variability in histology and clinical manifestation. Surgical resection remains the treatment of choice, but...
BACKGROUND
Ear canal and middle ear tumors are rare and exhibit variability in histology and clinical manifestation. Surgical resection remains the treatment of choice, but individualized approach is needed to preserve function when possible.
AIMS/OBJECTIVES
To review the management and outcome of ear canal and middle ear tumors at an academic referral center.
MATERIALS AND METHODS
Helsinki University Hospital (HUS) patient files were searched for clinically and histologically confirmed ear canal and middle ear tumors over a 14-year period. The minimum follow-up time was 2 years.
RESULTS
Eighty-seven patients with 88 tumors were identified. There were 20 (23%) benign external auditory canal (EAC), 36 (41%) benign middle ear space (MES), 29 (33%) malignant EAC, and 3 (3%) malignant MES tumors. Most (92%) tumors were managed with primary resection. Thirty-five percent of the operatively managed patients had a residual or a recurrent tumor.
CONCLUSIONS AND SIGNIFICANCE
EAC and MES tumors show great diagnostic and histologic heterogeneity with need for individualized investigative and treatment approaches. In benign tumors, we advocate aggressive local surgical control without sacrificing vital structures. In malignant tumors, we recommend local surgical control with or without adjunct RT.
Topics: Ear Canal; Ear Neoplasms; Ear, Middle; Humans; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 35148225
DOI: 10.1080/00016489.2022.2032824 -
Journal of Anatomy Feb 2016Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who... (Review)
Review
Middle ear surgery is strongly influenced by anatomical and functional characteristics of the middle ear. The complex anatomy means a challenge for the otosurgeon who moves between preservation or improvement of highly important functions (hearing, balance, facial motion) and eradication of diseases. Of these, perforations of the tympanic membrane, chronic otitis media, tympanosclerosis and cholesteatoma are encountered most often in clinical practice. Modern techniques for reconstruction of the ossicular chain aim for best possible hearing improvement using delicate alloplastic titanium prostheses, but a number of prosthesis-unrelated factors work against this intent. Surgery is always individualized to the case and there is no one-fits-all strategy. Above all, both middle ear diseases and surgery can be associated with a number of complications; the most important ones being hearing deterioration or deafness, dizziness, facial palsy and life-threatening intracranial complications. To minimize risks, a solid knowledge of and respect for neurootologic structures is essential for an otosurgeon who must train him- or herself intensively on temporal bones before performing surgery on a patient.
Topics: Ear Diseases; Ear, Middle; Hearing Loss; Humans
PubMed: 26482007
DOI: 10.1111/joa.12389