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American Journal of Otolaryngology 2023Microsurgical operations such as middle ear surgery rely heavily on visibility of the surgical field. Anesthetic techniques such as controlled hypotension have been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Microsurgical operations such as middle ear surgery rely heavily on visibility of the surgical field. Anesthetic techniques such as controlled hypotension have been developed to improve surgical field visibility by attempting to decrease bleeding. Many agents have been utilized to achieve controlled hypotension intraoperatively. Dexmedetomidine is a relatively newer agent which works on alpha-2 receptors to decrease sympathetic tone. This paper sought to determine the efficacy of dexmedetomidine for optimizing surgical field visibility in MES.
METHODS
A comprehensive search strategy was used in PubMed, SCOPUS, CINAHL, and CENTRAL through August 9, 2022 for this systematic review and meta-analysis.
INCLUSION CRITERIA
adult patients undergoing middle ear surgery with dexmedetomidine used for controlled hypotension to improve surgical field visibility. Risk of bias was assessed via Cochrane RoB 2. Meta-analysis of mean difference for surgical field scores and risk ratios for positive surgical field scores were used to compare dexmedetomidine with placebo or other agents.
RESULTS
Fourteen studies were included in this review. Statistically significant mean difference was found to favor dexmedetomidine over placebo for Fromme-Boezaart surgical field scores. Statistically significant results were also demonstrated favoring dexmedetomidine over other agents in risk ratio for receiving positive surgical field scores, as well as surgeon and patient satisfaction scores.
CONCLUSIONS
Controlled hypotension is an invaluable tool for surgical field visibility. Improved surgical field visibility was observed with dexmedetomidine compared with placebo and various other agents. Risk of sub-optimal bleeding scores was significantly lower with dexmedetomidine. Dexmedetomidine is effective at improving surgical field visibility in middle ear surgery.
Topics: Adult; Humans; Dexmedetomidine; Hypotension, Controlled; Ear, Middle; Otologic Surgical Procedures
PubMed: 37163960
DOI: 10.1016/j.amjoto.2023.103917 -
ORL; Journal For Oto-rhino-laryngology... 2016Since the middle ear cavity plays an important role in middle ear effusion, the goal of this study is to examine the morphological and functional development of the...
BACKGROUND/AIMS
Since the middle ear cavity plays an important role in middle ear effusion, the goal of this study is to examine the morphological and functional development of the middle ear mucosa in neonatal and adult gerbils.
METHODS
Gerbils aged between postnatal day 1 (P1) and P26 were used for the experiments. The morphological development of the middle ear cavity was measured by using the celloidin embedding method and scanning electronic microscope. Ciliary motion was determined and calibrated by a photodiode-based measurement system.
RESULTS
The area of the middle ear increased significantly from 0.42 ± 0.02 mm2 (n = 8) at P1 to 2.6 ± 0.03 mm2 (n = 8) at P26. At P1, all regions were covered by densely populated ciliated cells. A significant reduction of the density of ciliated cells was found between P8 and P18 (p < 0.05). The beat frequency at P1 is not statistically different from that of P8 (p > 0.05). However, the beat frequency increased significantly between P8 and P18 (p < 0.05).
CONCLUSION
Middle ear mucosa underwent a significant change between P1 and P18. The cilia morphology and function (ciliary motion) are fully mature at P18. This may explain the high incidence of middle ear effusion in the neonatal period in humans.
Topics: Age Factors; Animals; Animals, Newborn; Cilia; Ear, Middle; Gerbillinae; Microscopy, Electron, Scanning Transmission; Mucociliary Clearance; Nasal Mucosa
PubMed: 27880959
DOI: 10.1159/000452338 -
Audiology & Neuro-otology 2021The aim of this study was to investigate sclerostin (SOST) expression in a rat model of experimental tympanosclerosis (TS) and its possible role in the formation of TS.
OBJECTIVE
The aim of this study was to investigate sclerostin (SOST) expression in a rat model of experimental tympanosclerosis (TS) and its possible role in the formation of TS.
MATERIALS AND METHODS
Thirty-four SD rats were randomly divided into 2 groups: experimental group (n = 17) and normal group (n = 17). The left tympanic cavities in the experimental group were inoculated with methicillin-resistant Staphylococcus aureus. The changes of tympanic membranes were examined and recorded under otoendoscope. Haematoxylin-eosin staining was adopted to detect the morphological changes in the tympanic membrane and middle ear mucosa. Immunohistochemistry and Western blot analysis were used to observe the expression of SOST, Wnt3a, β-catenin, and P-ERK1/2.
RESULTS
In the experimental group, sclerotic lesions were observed in 54.5% ears in the end of 6 weeks. Morphological changes such as mucosa incrassation, inflammatory cells infiltration, fibrous tissue proliferation, and interstitial tissue incrassation prominently appeared in the tympanic membrane and middle ear mucosa. SOST protein was mainly distributed in the cytoplasm of epithelial cells and gland cells, the expression of which increased significantly in the calcified experimental ears. In addition, expression levels of Wnt3a, β-catenin, and P-ERK1/2 increased significantly in the calcified group too.
CONCLUSION
The upregulated expression level of SOST may be involved in the formation of TS, first, through the pro-phosphorylation of ERK1/2 in the inflammatory stage, and then through the enhancement of Wnt3a in the osteogenic stage.
Topics: Animals; Bone Morphogenetic Proteins; Disease Models, Animal; Ear, Middle; Genetic Markers; Male; Methicillin-Resistant Staphylococcus aureus; Myringosclerosis; Rats; Rats, Sprague-Dawley; Tympanic Membrane; beta Catenin
PubMed: 33508832
DOI: 10.1159/000508692 -
Auris, Nasus, Larynx Apr 2022To compare the prevalence of middle ear malformations between patients with and without congenital external auditory canal stenosis (CEACS) and to investigate the...
OBJECTIVE
To compare the prevalence of middle ear malformations between patients with and without congenital external auditory canal stenosis (CEACS) and to investigate the outcomes of tympanoplasty and/or canalplasty in terms of tympanic membrane (TM) size and external auditory canal (EAC) stenosis in patients with middle ear malformation.
METHODS
Twenty-five patients who underwent primary tympanoplasty and/or canalplasty for middle ear malformation at a tertiary academic medical center were retrospectively reviewed. CEACS was defined as an EAC diameter of 4 mm or less. Intraoperative findings, including irregularity of the ossicles, facial nerve, or chorda tympani; size of the TM and EAC on computed tomography; and pre- and postoperative hearing level, were collected.
RESULTS
We included 7 and 18 patients with and without CEACS, respectively. The malleus handle defect, anterior deviation of the chorda tympani, and small TM (≤7 mm) (p-values 0.015, <0.001, and 0.003, respectively; Fisher's exact test) had significantly higher prevalence in patients with CEACS than in those without. The mean postoperative air-bone gap (ABG) in patients with CEACS was not significantly different from that in patients with normal-sized EAC (20.6 dB and 19.5 dB, respectively; p-value, 0.121; Mann-Whitney U test). No difference was observed in mean postoperative ABG between patients with small TM and those with normal-sized TM (19.2 dB and 20.0 dB, respectively; p-value, 0.469; Mann-Whitney U test).
CONCLUSION
Patients with CEACS were more likely to have malleus handle defect, anterior deviation of the chorda tympani, and small TM than those without CEACS. Hearing outcome of patients with CEACS and a malformed malleus and/or incus might be equivalent to that of patients without CEACS following tympanoplasty and/or canalplasty, regardless of the EAC or TM size.
Topics: Constriction, Pathologic; Ear Canal; Ear, Middle; Humans; Prevalence; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34140215
DOI: 10.1016/j.anl.2021.05.005 -
Hearing Research Oct 2022Middle ear muscle contractions (MEMCs) are most commonly considered a response to high-level acoustic stimuli. However, MEMCs have also been observed in the absence of...
Middle ear muscle contractions (MEMCs) are most commonly considered a response to high-level acoustic stimuli. However, MEMCs have also been observed in the absence of sound, either as a response to somatosensory stimulation or in concert with other motor activity. The relationship between MEMCs and non-acoustic sources is unclear. This study examined associations between measures of voluntary unilateral eye closure and impedance-based measures indicative of middle ear muscle activity while controlling for demographic and clinical factors in a large group of participants (N=190) with present clinical acoustic reflexes and no evidence of auditory dysfunction. Participants were instructed to voluntarily close the eye ipsilateral to the ear canal containing a detection probe at three levels of effort. Orbicularis oculi muscle activity was measured using surface electromyography. Middle ear muscle activity was inferred from changes in total energy reflected in the ear canal using a filtered (0.2 to 8 kHz) click train. Results revealed that middle ear muscle activity was positively associated with eye muscle activity. MEMC occurrence rates for eye closure observed in this study were generally higher than previously published rates for high-level brief acoustic stimuli in the same participant pool suggesting that motor activity may be a more reliable elicitor of MEMCs than acoustic stimuli. These results suggest motor activity can serve as a confounding factor for auditory exposure studies as well as complicate the interpretation of any impulsive noise damage risk criteria that assume MEMCs serve as a consistent, uniform protective factor. The mechanism linking eye and middle ear muscle activity is not understood and is an avenue for future research.
Topics: Acoustic Stimulation; Ear, Middle; Hearing Tests; Humans; Muscle Contraction; Sound
PubMed: 35964452
DOI: 10.1016/j.heares.2022.108594 -
Otology & Neurotology : Official... Feb 2022Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear.
OBJECTIVE
Demonstrate the ability of a novel steerable distal chip endoscope to traverse the Eustachian tube and provide diagnostic quality images of the human middle ear.
PATIENTS
Three cadaveric temporal bone specimens were used in this work.
INTERVENTION
Diagnostic transeustachian endoscopy of the middle ear was performed.
MAIN OUTCOME MEASURE
Diagnostic image quality.
RESULTS
A novel 1.62 mm steerable endoscope successfully cannulated the Eustachian tube of three human cadaveric temporal bone specimens to reveal intact middle ear anatomy with high optical clarity.
CONCLUSIONS
A steerable endoscope can be designed to traverse the human Eustachian tube and provide diagnostic quality images of middle ear anatomy.
Topics: Cadaver; Ear, Middle; Endoscopes; Endoscopy; Eustachian Tube; Humans
PubMed: 34669684
DOI: 10.1097/MAO.0000000000003384 -
Molecules (Basel, Switzerland) Mar 2018Otitis media (OM) is a group of inflammatory diseases of the middle ear (ME), regardless of cause or pathological mechanism. Among the molecular biological studies... (Review)
Review
Otitis media (OM) is a group of 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 into the expression of C-type lectin receptors (CLR) in the ME and Eustachian tube (ET). To date, nine studies have evaluated CLR expression in the ME and ET. The expression of individual CLRs in mammalian ME and ET varies by species and model of OM. Assessments have shown that the patterns of CLR expression in the ME and ET vary; that CLR expression may vary by type of OM; and that the distribution and levels of expression of CLRs may depend on the presence or absence of inflammation, with variations even within the same species and same tissue. Infection of the ME and ET with various pathogens is a common cause of all types of OM, with host responses to pathogens mediated initially by the innate immune system. CLRs are important factors in the innate immune system because they act as both adhesion molecules and as pathogen recognition receptors. The expression of CLRs in OM tissues suggests that CLRs are associated with the pathogenesis of various types of OM.
Topics: Animals; Ear, Middle; Eustachian Tube; Humans; Lectins, C-Type; Otitis Media
PubMed: 29565818
DOI: 10.3390/molecules23040734 -
International Journal of Pediatric... Jan 2021Dermoid is a rare disease located in the head and neck and only sporadic cases were previously reported. Surgery with different operational paths is the best solution to...
OBJECTIVE
Dermoid is a rare disease located in the head and neck and only sporadic cases were previously reported. Surgery with different operational paths is the best solution to the disease. We aimed to analyze the clinical characteristics and outcomes of surgical approach for treating dermoid originated from the middle ear and Eustachian tube.
METHODS
In this retrospective case series, four cases of dermoids of the middle ear and Eustachian tube, treated by endoscopic-assisted surgical approach were reviewed and analyzed.
RESULTS
Patients' ages ranged from 7 months to 16 years. All cases involved the middle ear, eustachian tube, and the parapharyngeal space. Postoperative follow-up ranged from 6 months to 11 years. No facial nerve paralysis was observed during or after surgeries. Treatment was efficient in the four cases, with no residual symptoms during post-operative follow-up.
CONCLUSIONS
Dermoid of the middle ear involving the eustachian tube usually appears in children of early age. Surgical resection with assistance of endoscope has satisfying outcome for these cases.
Topics: Child; Dermoid Cyst; Ear, Middle; Endoscopes; Eustachian Tube; Humans; Infant; Retrospective Studies
PubMed: 33221033
DOI: 10.1016/j.ijporl.2020.110472 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Mar 2018Endoscopic transcannal middle ear surgery via natural route allows minimal surgery procedure which avoids incision of auricula and protects mastoid air cells. Utilizing... (Review)
Review
Endoscopic transcannal middle ear surgery via natural route allows minimal surgery procedure which avoids incision of auricula and protects mastoid air cells. Utilizing endoscope of different angles provides excellent views of the "hidden corner" in middle ear, therefore helping surgeons better get rid of reduce residual pathological tissues. Surgeons in otology should understand middle ear anatomy and physiology as well as master the use of endoscopic surgical instruments to perform procedures well. treatment methods was present so as to further improve the understanding of such kind of tumor.
Topics: Ear, Middle; Endoscopes; Endoscopy; Humans; Mastoid; Otologic Surgical Procedures
PubMed: 29798304
DOI: 10.13201/j.issn.1001-1781.2018.05.020 -
Frontiers in Cellular and Infection... 2021Acute otitis media (AOM) is commonly caused by bacterial pathobionts of the nasopharynx that ascend the Eustachian tube to cause disease in the middle ears. To model and...
Acute otitis media (AOM) is commonly caused by bacterial pathobionts of the nasopharynx that ascend the Eustachian tube to cause disease in the middle ears. To model and study the various complexities of AOM, common human otopathogens are injected directly into the middle ear bullae of rodents or are delivered with viral co-infections which contribute to the access to the middle ears in complex and partially understood ways. Here, we present the novel observation that , a well-characterized respiratory commensal/pathogen of mice, also efficiently ascends their Eustachian tubes to colonize their middle ears, providing a flexible mouse model to study naturally occurring AOM. Mice lacking T and/or B cells failed to resolve infections, highlighting the cooperative role of both in clearing middle ear infection. Adoptively transferred antibodies provided complete protection to the lungs but only partially protected the middle ears, highlighting the differences between respiratory and otoimmunology. We present this as a novel experimental system that can capitalize on the strengths of the mouse model to dissect the molecular mechanisms involved in the generation and function of immunity within the middle ear.
Topics: Animals; Bordetella bronchiseptica; Ear, Middle; Eustachian Tube; Mice; Nasopharynx; Otitis Media
PubMed: 35141173
DOI: 10.3389/fcimb.2021.815627