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Otology & Neurotology : Official... Oct 2023Papillomas originating from the Schneiderian epithelium within the middle ear are extremely rare and may be associated with a high rate of recurrence and malignant...
OBJECTIVE
Papillomas originating from the Schneiderian epithelium within the middle ear are extremely rare and may be associated with a high rate of recurrence and malignant transformation. Oncocytic papillomas represent the rarest pathological subtype of such tumors. The current investigation aimed to determine whether there exists a distinct mechanism underlying the incidence of oncocytic papillomas arising primarily within the middle ear, and to explore potential treatment strategies to ensure complete removal and prevent recurrence.
STUDY DESIGN
Search of the English literature for cases of middle ear papilloma and RNA sequencing analysis of three samples from one new case presenting at the Eye and ENT Hospital, Fudan University (Shanghai, China), with recurrent middle ear oncocytic papilloma, along with two normal mucosal samples.
SETTING
Academic, tertiary referral hospital.
PATIENT AND INTERVENTIONS
The patient underwent open mastoidectomy and endoscopic tympanoplasty twice in 6 years. Histopathology confirmed oncocytic papilloma in middle ear. The patient has been free of the disease at 18 months of follow-up without radiation, whereas the RNA-seq analysis of the samples in endoscopic operations remained nonmalignant.
RESULTS
Only four cases of primary middle ear oncocytic papillomas have been reported. Recurrent masses usually originate from around the eustachian tube, which may explain the pathogenesis of this lesion. RNA-seq analysis was used to identify 1,317 (UP, 239; DOWN, 1078) differentially expressed genes between papillomas and normal mucosa. The involvement of some hub proteins (e.g., FN1, CXCL8, L10, JUN, and FOS) in the pathogenesis of primary middle ear papillomas was found to align with the observed clinical features.
CONCLUSION
The middle ear oncocytic papillomas were extremely rare and remained incompletely understood. The findings of this first RNA-seq analysis of this rare tumor may serve to enhance comprehension of and aid in the management of middle ear papillomas.
Topics: Humans; China; Ear, Middle; Papilloma; Endoscopy; Eustachian Tube
PubMed: 37604509
DOI: 10.1097/MAO.0000000000003993 -
American Journal of Otolaryngology 2022To perform a systematic review of the diagnosis and treatment of patients with pulsatile tinnitus secondary to middle ear myoclonus.
OBJECTIVE
To perform a systematic review of the diagnosis and treatment of patients with pulsatile tinnitus secondary to middle ear myoclonus.
DATABASES REVIEWED
PubMed, EMBASE, and Scopus.
METHODS
A systematic review was performed using standardized methodology. Computerized and manual searches were performed to identify studies of all ages (patients) who had middle ear myoclonus (intervention). All study designs were assessed. Extracted data included demographics, clinical features, duration of followup as well as the diagnosis and reversibility of symptoms with medical or surgical intervention. Studies were included if they included subjects with middle ear myoclonus. Exclusion criteria included letters/commentaries and reviews.
RESULTS
Twenty articles representing 115 subjects with middle ear myoclonus were included. The mean age was 29.7 (range 6-67). The follow-up period ranged from 5 weeks to 36 months. Primary treatment consists of medical therapy utilising anxiolytics, antiepileptics, botulinum toxin and surgical treatment involving division of middle ear muscular tendon(s). In total, 60 patients underwent middle ear muscular tenotomies, with division of both stapedius and tensor tympani tendons being the most prevalent (88%). Limitations in the data arose from study design, related comorbidities such as palatal myoclonus, and concomitant drug administration. No study provided any objective criteria to diagnose this condition or evaluate post-treatment outcome.
CONCLUSION
Middle ear myoclonus is an entity that is poorly assessed in the literature. There is a lack of consensus regarding the criteria and strategies for both diagnosing and treating this condition. Although level of evidence of current studies remains modest, it is felt that a stepwise approach is deemed best, with therapeutic decisions being made on an individual basis, evaluating each patient's specific circumstances and priorities.
Topics: Adolescent; Adult; Aged; Anti-Anxiety Agents; Anticonvulsants; Botulinum Toxins; Central Nervous System Agents; Child; Ear Diseases; Ear, Middle; Female; Humans; Male; Middle Aged; Myoclonus; Tenotomy; Treatment Outcome; Young Adult
PubMed: 34537509
DOI: 10.1016/j.amjoto.2021.103228 -
The Journal of Experimental Biology Nov 2022In most anuran amphibians, acoustic communication is of prime importance for mate localization and selection. The tympanic middle ear increases auditory sensitivity and...
In most anuran amphibians, acoustic communication is of prime importance for mate localization and selection. The tympanic middle ear increases auditory sensitivity and directionality and is therefore expected to be favoured by natural selection. However, especially within the family of true toads (Bufonidae) there is a tendency for species to lose parts of the middle ear apparatus and consequently have a reduced sensitivity to high-frequency sounds (above 1 kHz). Part of the explanation for this may be that development of the middle ear is especially slow in bufonids, and thus the middle ear would be more likely to be lost or non-functional in paedomorphic species. However, a timeline of development of the middle ear has not been established previously. The goal of the present study was to investigate middle ear development in a toad species that has a well-known natural history and acoustic communication behaviour. We made a detailed study of anatomy and biophysics of the middle ear with measurements of auditory sensitivity across age in post-metamorphic natterjack toads (Epidalea calamita). The tadpoles and toadlets were raised in the laboratory, so their exact age was known, their auditory sensitivity was measured using auditory brainstem responses, and middle ear development and function were assessed by anatomical studies and laser vibrometry. We found that the developmental stage of the middle ear depends on the size of the toad rather than its age. The middle ear was functional at the earliest at a snout-vent length of 40 mm, which for these toads was around 500 days post-metamorphosis, close to the time of first reproduction. The functional, adult-like middle ear was shown to have 30 dB increased sensitivity to the dominant frequency of the mating call compared with sensitivities measured in newly metamorphosed individuals.
Topics: Humans; Animals; Bufonidae; Ear, Middle; Tympanic Membrane; Larva; Metamorphosis, Biological
PubMed: 36268787
DOI: 10.1242/jeb.244759 -
Otology & Neurotology : Official... Sep 2021The light emitted from the endoscope during transcanal endoscopic ear surgery (TEES) heats the intratympanic space. This heat may potentially be dangerous to nearby...
OBJECTIVE
The light emitted from the endoscope during transcanal endoscopic ear surgery (TEES) heats the intratympanic space. This heat may potentially be dangerous to nearby important structures, as documented by in vitro and by animal and cadaveric studies. The aim of our work was to monitor middle ear temperatures during TEES in vivo.
STUDY DESIGN
Cohort study.
SETTING
Tertiary referral hospital.
PATIENTS
Four patients (15-69 yrs old) underwent transcanal endoscopic tympanoplasties for chronic perforation or retraction.
INTERVENTION
After elevating the tympanomeatal flap, a thermocouple was placed in the middle ear to measure the heat generated by a 30° Hopkins rod telescope (11 cm long, 2.7 mm wide) and fiberoptic light emitting diode light source.
MAIN OUTCOME MEASURES
Middle ear temperature in the retrotympanum was monitored under these conditions: at 50 and 100% light intensity, after removing and wiping the endoscope tip, during suctioning and following middle ear irrigation.
RESULTS
Maximum middle ear temperature ranged from 36.26-37.30°C. Pulling out and wiping the endoscope caused no change or minimal decrease of 0.16°C. Middle ear irrigation caused a temperature drop of 2.05°C to 5.11°C. Suctioning was associated with a drop from 0.24°C to 3.91°C that was dependent on the depth of the endoscopic tip.
CONCLUSION
Middle ear temperatures during TEES using a Hopkins rod telescope and light-emitting diode light source reach values corresponding to physiological body temperature, and do not reach dangerous levels.
Topics: Body Temperature; Cohort Studies; Ear, Middle; Endoscopy; Humans; Otologic Surgical Procedures; Temperature
PubMed: 33741819
DOI: 10.1097/MAO.0000000000003142 -
Journal of Comparative Physiology. A,... Sep 2020The sheep middle ear has been used in training to prepare physicians to perform surgeries and to test new ways of surgical access. This study aimed to (1) collect... (Comparative Study)
Comparative Study
The sheep middle ear has been used in training to prepare physicians to perform surgeries and to test new ways of surgical access. This study aimed to (1) collect anatomical data and inertial properties of the sheep middle-ear ossicles and (2) explore effects of these features on sound transmission, in comparison to those of the human. Characteristic dimensions and inertial properties of the middle-ear ossicles of White-Alpine sheep (n = 11) were measured from high-resolution micro-CT data, and were assessed in comparison with the corresponding values of the human middle ear. The sheep middle-ear ossicles differed from those of human in several ways: anteroinferior orientation of the malleus handle, relatively small size of the incus with a relatively short distance to the lenticular process, a large area of the articular surfaces at the incudostapedial joint, and a relatively small moment of inertia along the anterior-posterior axis. Analysis in this study suggests that structure and orientation of the middle-ear ossicles in the sheep are conducive to an increase in the hinge-like ossicular-lever-action around the anterior-posterior axis. Considering the substantial anatomical differences, outcomes of middle-ear surgeries would presumably be difficult to assess from experiments using the sheep middle ear.
Topics: Animals; Ear Ossicles; Ear, Middle; Hearing; Humans; Incus; Malleus; Sheep
PubMed: 32564138
DOI: 10.1007/s00359-020-01430-w -
International Journal of Molecular... Oct 2017Otitis media (OM) refers to inflammatory diseases of the middle ear (ME), regardless of cause or pathological mechanism. Among the molecular biological studies assessing... (Review)
Review
Otitis media (OM) refers to inflammatory diseases of the middle ear (ME), regardless of cause or pathological mechanism. Among the molecular biological studies assessing the pathology of OM are investigations of the expression of aquaporins (AQPs) in the ME and Eustachian tube (ET). To date, fifteen studies have evaluated AQPs expression in the ME and ET. Although the expression of individual AQPs varies by species and model, eleven types of AQP, AQP1 to AQP11, were found to be expressed in mammalian ME and ET. The review showed that: (1) various types of AQPs are expressed in the ME and ET; (2) AQP expression may vary by species; and (3) the distribution and levels of expression of AQPs may depend on the presence or absence of inflammation, with variations even in the same species and same tissue. Fluid accumulation in the ME and ET is a common pathological mechanism for all types of OM, causing edema in the tissue and inducing inflammation, thereby possibly involving various AQPs. The expression patterns of several AQPs, especially AQP1, 4 and 5, were found to be altered in response to inflammatory stimuli, including lipopolysaccharide (LPS), suggesting that AQPs may have immunological functions in OM.
Topics: Animals; Aquaporins; Cell Membrane Permeability; Ear, Middle; Eustachian Tube; Gene Expression Regulation; Humans; Multigene Family; Otitis Media
PubMed: 29039751
DOI: 10.3390/ijms18102164 -
Scientific Reports Oct 2022Human temporal bone specimens are used in experiments measuring the sound transfer of the middle ear, which is the standard method used in the development of active and...
Human temporal bone specimens are used in experiments measuring the sound transfer of the middle ear, which is the standard method used in the development of active and passive middle ear implants. Statistical analyses of these experiments usually require that the TB samples are representative of the population of non-pathological middle ears. Specifically, this means that the specimens must be mechanically well-characterized. We present an in-depth statistical analysis of 478 data sets of middle ear transfer functions (METFs) from different laboratories. The data sets are preprocessed and various contributions to the variance of the data are evaluated. We then derive a statistical range as a reference against which individual METF measurements may be validated. The range is calculated as the two-sided 95% tolerance interval at audiological frequencies. In addition, the mean and 95% confidence interval of the mean are given as references for assessing the validity of a sample group. Finally, we provide a suggested procedure for measuring METFs using the methods described herein.
Topics: Ear, Middle; Humans; Ossicular Prosthesis; Sound; Temporal Bone
PubMed: 36241675
DOI: 10.1038/s41598-022-21245-w -
Current Opinion in Otolaryngology &... Oct 2016The aim of this review is to study the rationale, limitations, techniques, and long-term outcomes of endoscopic ear surgery. (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to study the rationale, limitations, techniques, and long-term outcomes of endoscopic ear surgery.
RECENT FINDINGS
The article discusses the advantages of endoscopic ear surgery in treating cholesteatoma and how the hidden sites like facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope.
SUMMARY
Transcanal endoscopic approach allows minimally invasive removal of cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.
Topics: Algorithms; Cholesteatoma, Middle Ear; Ear, Middle; Endoscopy; Humans
PubMed: 27455032
DOI: 10.1097/MOO.0000000000000296 -
Otolaryngology--head and Neck Surgery :... Apr 2017Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system.... (Review)
Review
Objective In this report, we review the recent literature (ie, past 4 years) to identify advances in our understanding of the middle ear-mastoid-eustachian tube system. We use this review to determine whether the short-term goals elaborated in the last report were achieved, and we propose updated goals to guide future otitis media research. Data Sources PubMed, Web of Science, Medline. Review Methods The panel topic was subdivided, and each contributor performed a literature search within the given time frame. The keywords searched included middle ear, eustachian tube, and mastoid for their intersection with anatomy, physiology, pathophysiology, and pathology. Preliminary reports from each panel member were consolidated and discussed when the panel met on June 11, 2015. At that meeting, the progress was evaluated and new short-term goals proposed. Conclusions Progress was made on 13 of the 20 short-term goals proposed in 2011. Significant advances were made in the characterization of middle ear gas exchange pathways, modeling eustachian tube function, and preliminary testing of treatments for eustachian tube dysfunction. Implications for Practice In the future, imaging technologies should be developed to noninvasively assess middle ear/eustachian tube structure and physiology with respect to their role in otitis media pathogenesis. The new data derived from these structure/function experiments should be integrated into computational models that can then be used to develop specific hypotheses concerning otitis media pathogenesis and persistence. Finally, rigorous studies on medical or surgical treatments for eustachian tube dysfunction should be undertaken.
Topics: Animals; Congresses as Topic; Ear, Middle; Eustachian Tube; Humans; Mastoid; Models, Animal
PubMed: 28372527
DOI: 10.1177/0194599816647959 -
The British Journal of Radiology May 2020Active middle ear implants augment sound waves and directly stimulate the middle ear structures. The most frequently utilised active middle ear implant is the Vibrant... (Review)
Review
Active middle ear implants augment sound waves and directly stimulate the middle ear structures. The most frequently utilised active middle ear implant is the Vibrant Soundbridge (VSB).CT plays a vital role in appropriate patient selection and surgical planning of active middle ear implant surgery. The VSB offers a number of options for implant placement. The ideal location is influenced by the patient's middle ear and mastoid anatomy as well as the type and severity of the hearing loss. CT provides important information on the surgical access to the middle ear and helps determine the most appropriate implant site by assessing the adjacent middle ear anatomy and the continuity of the ossicular chain. Post-operative active middle ear implant imaging may be indicated in the setting of poor auditory outcomes and when revision surgery is being considered so as to assess for suboptimal implant placement or migration.This pictorial review will describe the VSB middle ear device and explain the role of imaging in both the pre-operative and post-operative settings.
Topics: Adult; Checklist; Ear, Middle; Hearing Loss; Humans; Ossicular Prosthesis; Patient Care Planning; Postoperative Care; Preoperative Care; Prosthesis Design; Sound; Tomography, X-Ray Computed; Vibration
PubMed: 31944820
DOI: 10.1259/bjr.20190741