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The International Tinnitus Journal Mar 2024Opacification in the middle ear and mastoid region can stem from a wide range of factors. In terms of diagnostic imaging, CT is the primary tool due to its exceptional... (Review)
Review
Opacification in the middle ear and mastoid region can stem from a wide range of factors. In terms of diagnostic imaging, CT is the primary tool due to its exceptional spatial resolution, particularly for examining the temporal bone and ossicles. MRI complements this by offering detailed soft tissue lesion characterization and assessing involvement in the inner ear and cranial nerves. This study focuses on inflammatory causes of opacification in the middle ear and mastoid, with an emphasis on the utility of CT and MRI. This comprehensive review aimed to provide a practical framework for considering potential differential diagnoses.
Topics: Humans; Tomography, X-Ray Computed; Ear, Middle; Temporal Bone; Mastoid; Magnetic Resonance Imaging
PubMed: 38507628
DOI: 10.5935/0946-5448.20230023 -
Otology & Neurotology : Official... Jul 2019To assess the association of middle ear volume with long-term hearing outcomes in congenital aural atresia (CAA) repair.
OBJECTIVE
To assess the association of middle ear volume with long-term hearing outcomes in congenital aural atresia (CAA) repair.
STUDY DESIGN
Retrospective chart and radiological review.
SETTING
Single academic tertiary referral center.
PATIENTS
Children and adults who underwent CAA repair between 1995 and 2016. Patients were divided into "best" and "worst" audiometric groups, based on stability of postoperative air conduction pure-tone average (AC PTA) results. Ten patients were included for study in the "best" group, and 12 in the "worst" group.
INTERVENTION(S)
CAA repair.
MAIN OUTCOME MEASURE(S)
Long-term (> 1 yr) postoperative three-tone (500, 1000, 2000 Hz) AC PTA, speech reception threshold (SRT), air bone gap, and semiautomated calculated middle ear volume from preoperative computed tomography (CT) scans.
RESULTS
Statistically significant differences were noted between "best" and "worst" groups in AC PTA, SRT, and air bone gap (p < 0.001). Mean middle ear volume in the "best" group was 434.6 mm (range 326.3-602.1 mm) and 339.5 mm (range 199.4-502.1 mm) in the "worst" group (p = 0.02). The majority in both groups were right ears (p = 0.38), and males outnumbered females in the "best" group (9 out of 10; p = 0.018). Preoperative Jahrsdoerfer grading scores were similar between groups (p = 0.31). Mean follow-up for the "best" and "worst" groups was approximately 3.5 and 4.5 yr, respectively.
CONCLUSIONS
For patients undergoing CAA repair, larger middle ear volume is associated with stable and better long-term audiometric outcomes.
Topics: Adolescent; Child; Congenital Abnormalities; Ear; Ear, Middle; Female; Hearing; Hearing Tests; Humans; Male; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31135676
DOI: 10.1097/MAO.0000000000002233 -
Surgical Innovation Jun 2022In otolaryngologic surgery, more and more robots are being studied to meet the clinical needs of operating rooms. However, to help design and optimize these robots, the...
In otolaryngologic surgery, more and more robots are being studied to meet the clinical needs of operating rooms. However, to help design and optimize these robots, the workspace must be precisely defined taking into account patient variability. The aim of this work is to define a geometric atlas of the middle ear and paranasal sinuses for endoscopic robotic applications. Scans of several patients of different ages and sexes were used to determine the average size of these workspaces, which are linked by the similar use of endoscopes in surgery.
Topics: Ear, Middle; Endoscopes; Endoscopy; Humans; Paranasal Sinuses; Robotic Surgical Procedures; Robotics
PubMed: 34605327
DOI: 10.1177/15533506211039675 -
Veterinary Pathology Sep 2014The purpose of this study was to establish microscopic normal in the middle ear of the cat while concurrently characterizing gross and microscopic lesions reflecting...
The purpose of this study was to establish microscopic normal in the middle ear of the cat while concurrently characterizing gross and microscopic lesions reflecting spontaneous otitis media. Both ears from 50 cats were examined grossly and processed for histologic examination of the external, middle, and internal ear on a single slide. Gross lesions of the middle ear were present in 14 of 100 (14%) and included turbid fluid, frank pus, hemorrhage, and fibrous thickening of the auricular mucoperiosteum. Histologically, 48 of 100 (48%) ears had evidence of ongoing or previous inflammatory middle ear disease, including proteinaceous fluid; vascular ectasia; expansion of the auricular mucoperiosteum by neutrophils, lymphocytes, and macrophages; cholesterol clefts; hemorrhage; fibrin; granulation tissue; membranous pseudo-glands; fibrosis; proliferation and/or osteolysis of the tympanic and septum bullae. Histologic lesions were identified in 34 of 100 ears (34%) lacking gross evidence of disease. Ears were classified histologically as either normal (52/100 [52%]) or diseased (48/100 [48%]). Diseased ears were further classified as mild to moderate (37/100 [37%]) or severely (11/100 [11%]) affected. Internal ear involvement was present in 11 of 100 (11%) ears. Histologic evidence of middle ear disease in cats is far greater than gross lesions or clinical literature suggests; further investigation and correlation of clinical and histologic disease are warranted. With minimal additional preparation, diagnostic specimens may be readily prepared and evaluated for this integral sensing organ.
Topics: Animals; Cat Diseases; Cats; Ear, Middle; Female; Male; Otitis Media; Reproducibility of Results
PubMed: 24280942
DOI: 10.1177/0300985813511125 -
American Journal of Otolaryngology 2022The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear...
BACKGROUND
The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps.
OBJECTIVES
To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery.
METHODS
We prospectively evaluated data of patients undergoing middle ear surgery for chronic otitis media with and without cholesteatoma. All patients completed the SNOT-22 and ETDQ-7 questionnaires. They underwent surgery for their pathology, as appropriate.
RESULTS
The SNOT-22 score was higher in patients with retraction pocket and in patients whose retraction pockets recurred after surgery (p < 0.05). Patients with higher score at SNOT-22 questionnaire, were more likely to show recurrence of atelectasis aftersurgery.
CONCLUSIONS
The SNOT-22 questionnaire, administrered before surgical procedure, can help in the identification of patients who are at risk of failure in the post-operative period, as well as ETDQ-7.
Topics: Chronic Disease; Ear Diseases; Ear, Middle; Eustachian Tube; Humans; Prognosis; Sino-Nasal Outcome Test
PubMed: 35537229
DOI: 10.1016/j.amjoto.2022.103480 -
The Journal of the Acoustical Society... Nov 2019The use of models to predict the effect of blast-like impulses on hearing function is an ongoing topic of investigation relevant to hearing protection and hearing-loss... (Review)
Review
The use of models to predict the effect of blast-like impulses on hearing function is an ongoing topic of investigation relevant to hearing protection and hearing-loss prevention in the modern military. The first steps in the hearing process are the collection of sound power from the environment and its conduction through the external and middle ear into the inner ear. Present efforts to quantify the conduction of high-intensity sound power through the auditory periphery depend heavily on modeling. This paper reviews and elaborates on several existing models of the conduction of high-level sound from the environment into the inner ear and discusses the shortcomings of these models. A case is made that any attempt to more accurately define the workings of the middle ear during high-level sound stimulation needs to be based on additional data, some of which has been recently gathered.
Topics: Animals; Blast Injuries; Ear, External; Ear, Middle; Hearing Loss, Noise-Induced; Humans; Models, Neurological; Sound
PubMed: 31795712
DOI: 10.1121/1.5132288 -
Journal of the Association For Research... Dec 2022Tympanometry provides an objective measurement of the status of the middle ear. During tympanometry, the ear-canal pressure is varied, while the response of the ear to...
Tympanometry provides an objective measurement of the status of the middle ear. During tympanometry, the ear-canal pressure is varied, while the response of the ear to sound pressure is measured. The effects of the pressure on the mechanics of the middle ear are not well understood. This study is a continuation of our previous work in which the vibration response of the gerbil eardrum was measured in vivo under quasi-static pressure steps. In this study, we delivered a continuous pressure sweep to the middle ear and measured the vibration response at four locations for six gerbils. Vibrations were recorded using a single-point laser Doppler vibrometer and glass-coated reflective beads (diameter ~ 40 µm) at the umbo and on the mid-manubrium, posterior pars tensa and anterior pars tensa.The vibration magnitudes were similar to those in the previous step-wise pressurization experiments. Most gerbils showed repeatability within less than 10 dB for consecutive cycles. As described in the previous study, as the frequency was increased at ambient pressure, the vibration magnitude on the manubrium increased slightly to a broad peak (referred to as R1) and then decreased until a small peak appeared (referred to as R2), followed by multiple peaks and troughs as the magnitude decreased further. The low-frequency vibration magnitude (at 1 kHz) decreased monotonically as the pressure became more negative except for a dip (about 500 Pa wide) that occurred between - 700 and - 1800 Pa. The lowest overall magnitude was recorded in the dip at mid-manubrium. The vibration magnitudes also decreased as the middle-ear pressure was made more positive and were larger than those at negative pressures. R1 was only visible at negative and small positive middle-ear pressures, while R2 was visible for both positive and negative pressures. R2 split into multiple branches after the middle-ear pressure became slightly positive. No magnitude dip was visible for positive middle-ear pressures.The low-frequency vibration magnitudes at negative middle-ear pressures on the pars tensa were higher than those on the manubrium. R1 was not visible for large negative middle-ear pressures on the pars tensa. R2 appeared as a multi-peak feature on the pars tensa as well, and a higher-frequency branch on the posterior pars tensa appeared as a trough on the anterior pars tensa. The magnitude dip was not present on the pars tensa. The largest overall magnitude was recorded at the R2 peak on the posterior pars tensa.The results of this study expand on the findings of the step-wise pressurization experiments and provide further insight into the evolution of the vibration response of the eardrum under quasi-static pressures.
Topics: Animals; Tympanic Membrane; Vibration; Gerbillinae; Ear, Middle; Sound
PubMed: 36100816
DOI: 10.1007/s10162-022-00867-x -
Journal of Visualized Experiments : JoVE Jan 2018The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to...
The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes. The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.
Topics: Ear, Middle; Endoscopy; Humans; Manuals as Topic; Otologic Surgical Procedures
PubMed: 29364219
DOI: 10.3791/56390 -
Zoology (Jena, Germany) Feb 2018Static pressure changes can alter the configuration and mechanical behavior of the chain of ossicles, which may affect the acoustic transfer function. In mammals, the...
Static pressure changes can alter the configuration and mechanical behavior of the chain of ossicles, which may affect the acoustic transfer function. In mammals, the Eustachian tube plays an important role in restoring ambient middle ear pressure, hence restoring the acoustic transfer function and excluding barotrauma of the middle and inner ear. Ambient pressure fluctuations can be potentially extreme in birds and due to the simple structure of the avian middle ear (one ossicle, one muscle), regulation of the middle ear pressure via reflexive opening of the pharyngotympanic tube appears all the more important. In this study the deformations of the chicken (Gallus gallus domesticus) middle ear structures, as a result of middle ear pressure alterations, are quantified, using micro-CT scanning. It was experimentally tested whether reflexive opening of the pharyngotympanic tube to restore ambient middle ear pressure is present in chicken and mallard (Anas platyrhynchos) and whether this mechanism depends on sensing middle ear pressure indirectly via deformations of the middle ear components or sensing the middle ear pressure directly. A translation of the columella footplate was observed when middle ear pressure was kept at 1kPa and -1kPa relative to ambient pressure. Deformation of the tympanic membrane was larger than the columella footplate translation. Bending and deformation of the extracolumella was observed. Opening of the pharyngotympanic tube occurred at random pressure for both chicken and mallard when middle ear pressure was raised and lowered by 1.5kPa relative to ambient pressure. We also did not find a difference in middle ear venting rate when middle ear pressure was held constant at 0.5, 1, 1.5, -0.5, -1 and -1.5kPa for chickens and at 1, 2, 4, -1, -2 and -4kPa for mallards. As a result, no statement can be made about pressure within the avian middle ear being measured directly or indirectly. Our experiments do not support the presence of a short-loop reflexive control of pressure equilibration via the pharyngotympanic tube. However, it is still possible that triggering this loop requires additional sensorial input (e.g. visual, vestibular) or that it occurs voluntarily (being controlled at a higher brain level).
Topics: Animals; Atmospheric Pressure; Birds; Chickens; Ducks; Ear, Middle; Female; Tympanic Membrane
PubMed: 29157881
DOI: 10.1016/j.zool.2017.11.003 -
Aerospace Medicine and Human Performance 2016Barotrauma is a frequent problem in aviation medicine. Eustachian tube dysfunction plays a critical role in the pathogenesis of barotrauma. Function of the Eustachian...
BACKGROUND
Barotrauma is a frequent problem in aviation medicine. Eustachian tube dysfunction plays a critical role in the pathogenesis of barotrauma. Function of the Eustachian tube can be indirectly assessed by multifrequency tympanometry, which provides valuable information about the resistance and permeability of the middle ear in a wide frequency range. The aim of this study was to research whether multifrequency tympanometry could be used for assessing middle ear impairments in pilots.
METHODS
There were 140 pilots and pilot candidates between the ages of 20-55 with normal otoscopic examination who were evaluated by audiological test batteries. Body mass index values, flight hours, audiometric pure tone thresholds, tympanometry and multifrequency tympanometry test results were noted.
RESULTS
There was statistically significant decrease in the multifrequency tympanometry measurements of the left and right ears of the pilots with 200-3000 flight hours compared to pilot candidates, and similarly, the pilots with 3000-10,000 flight hours compared to pilot candidates.
DISCUSSION
Multifrequency tympanometry values changed between pilot candidates and pilots. However, the values of multifrequency tympanometry did not change due to flight hours. This test battery should not be used for follow up of pilots in the clinic. Tuncer MM, Babakurban ST, Aydin E. Middle ear resonance frequency in pilots and pilot candidates. Aerosp Med Hum Perform. 2016; 87(10):876-881.
Topics: Acoustic Impedance Tests; Adult; Aerospace Medicine; Audiometry, Pure-Tone; Barotrauma; Case-Control Studies; Ear, Middle; Eustachian Tube; Humans; Middle Aged; Occupational Exposure; Pilots; Prospective Studies; Time Factors; Young Adult
PubMed: 27662350
DOI: 10.3357/AMHP.4554.2016