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The Journal of International Advanced... Apr 2019The stapes surgery has evolved through different eras of technical and technological development. The current standard of care is creating a stapedotomy with piston... (Comparative Study)
Comparative Study Review
The stapes surgery has evolved through different eras of technical and technological development. The current standard of care is creating a stapedotomy with piston placement, and both these aspects have multiple variations and show well-established technological advances. The conventional technique has been fairly standardized,and it offers gratifying results to both the surgeon and the patient. To overcome certain procedural risks and potential complications, the reversal of steps technique was developed and streamlined by Ugo Fisch in the early 1980s. Since its beginning, the technique has been adopted by various centers, and surgical outcomes have been demonstrated to be at par with the conventional technique, with a reduced risk of complications. The aim of the present review is to detail the various surgical nuances and outcomes of this particular technique in a comprehensive narrative manner.
Topics: Clinical Competence; Ear, Middle; Humans; Narration; Otosclerosis; Postoperative Complications; Stapes Surgery; Surgeons; Treatment Outcome
PubMed: 30924781
DOI: 10.5152/iao.2019.6800 -
Ear, Nose, & Throat Journal Dec 2021To analyze the clinical characteristics of congenital cholesteatoma (CC), to explore the risk factors related to recurrence of the disease, and to clarify the importance...
OBJECTIVES
To analyze the clinical characteristics of congenital cholesteatoma (CC), to explore the risk factors related to recurrence of the disease, and to clarify the importance of staging for treatment.
METHODS
A total of 87 patients were followed up for more than 5 years, who had undergone surgical procedures for CC from September 2010 to January 2017 in Beijing Children's Hospital, Capital Medical University. Patients with CC were identified in accordance with the following Levenson's criteria. The clinical characteristics of CC on different stage and risk factors related to recurrence of the disease were analyzed.
RESULTS
Canal wall up mastoidectomy and tympanoplasty (n = 45), transcanal endoscopic approach (n = 29), and canal wall down mastoidectomy and tympanoplasty (n = 13) was, respectively, performed depending on cholesteatoma extension. Between 2010 and 2013, 20.93% of patients had stage I-II disease, whereas 61.26% had stage I-II disease from 2014 to 2017. Meanwhile, the proportion with stage III-IV disease decreased from 79.07% to 38.64% between these 2 time periods. The preoperative air conduction threshold in patients with stage I, II, III, and IV was, respectively, 23.36 ± 8.20, 45.40 ± 12.82, 47.49 ± 12.03, and 50.37 ± 11.80 dB. The stage of disease was a significant risk factor regarding recurrence ( = .02). Surgery on patients with stage III-IV disease was performed with the aid of a microscope from 2010 to 2013 and with a microscope and endoscope from 2014 to 2017, which reduced the recurrence rate from 26.92% in the former period to 8.33% in the latter period.
CONCLUSION
Early detection of CC is crucial regarding the facilitation of minimally invasive surgery and reducing complication and recurrence rates. The stage of the disease is a significant risk factor regarding recurrence. The surgery shows us the possibility of reducing the recurrence rate of CC, which is performed under a microscope and an endoscope.
Topics: Child; Child, Preschool; Cholesteatoma; Cholesteatoma, Middle Ear; Ear, Middle; Early Diagnosis; Endoscopy; Female; Humans; Male; Mastoidectomy; Microscopy; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome; Tympanoplasty
PubMed: 32603216
DOI: 10.1177/0145561320933965 -
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 -
Hearing Research Feb 2017The goal of the current study was to characterize the normative features of wideband acoustic immittance in children for describing the functional maturation of the... (Comparative Study)
Comparative Study
The goal of the current study was to characterize the normative features of wideband acoustic immittance in children for describing the functional maturation of the middle ear in 5 to 12-year-old children. Absorbance and group delay were measured in adults and three groups of children, 5-6, 7-9 and 10-12-year-olds, in a cross-sectional design. Absorbance showed significant effects of the age group in four out of ten center frequencies of one-half-octave bins from 211 to 6000 Hz, while there was no significant effect for group delay at any frequency. Older children (10-12 years) showed absorbance similar to adults. Test-retest reliability was high for absorbance for all age groups. However, group delay was modestly reliable only for adults. We conclude that the middle ear transmission follows a protracted period of maturation for high frequencies and reaches adult-like feature by 10-12 years of age.
Topics: Absorption, Physicochemical; Acoustic Stimulation; Adult; Age Factors; Child; Child Development; Child, Preschool; Cross-Sectional Studies; Ear, Middle; Female; Hearing; Humans; Male; Motion; Pressure; Sound; Young Adult
PubMed: 27816500
DOI: 10.1016/j.heares.2016.10.029 -
Frontiers in Cellular and Infection... 2019Chronic otitis media with effusion (COME) is a common childhood disease characterized by an accumulation of fluid behind the eardrum. COME often requires surgical...
Chronic otitis media with effusion (COME) is a common childhood disease characterized by an accumulation of fluid behind the eardrum. COME often requires surgical intervention and can also lead to significant hearing loss and subsequent learning disabilities. Recent characterization of the middle ear fluid (MEF) microbiome in pediatric patients has led to an improved understanding of the microbiota present in the middle ear during COME. However, it is not currently known how the MEF microbiome might vary due to other conditions, particularly respiratory disorders. Here, we apply an amplicon sequence variant (ASV) pipeline to MEF 16S rRNA high-throughput sequencing data from 50 children with COME (ages 3-176 months) undergoing tube placement. We achieve a more detailed taxonomic resolution than previously reported, including species and genus level resolution. Additionally, we provide the first report of the functional roles of the MEF microbiome and demonstrate that despite high taxonomic diversity, the functional capacity of the MEF microbiome remains uniform between patients. Furthermore, we analyze microbiome differences between children with COME with and without a history of lower airway disease (i.e., asthma or bronchiolitis). The MEF microbiome was less diverse in participants with lower airway disease than in patients without, and phylogenetic β-diversity (weighted UniFrac) was significantly different based on lower airway disease status. Differential abundance between patients with lower airway disease and those without was observed for the genera , and . These findings support previous suggestions of a link between COME and respiratory illnesses and emphasize the need for future study of the middle ear and respiratory tract microbiomes in diseases such as asthma and bronchiolitis.
Topics: Biodiversity; Child; Child, Preschool; Chronic Disease; Ear, Middle; Female; Humans; Infant; Male; Metagenomics; Microbiota; Otitis Media with Effusion; Phylogeny; RNA, Ribosomal, 16S; Respiratory Tract Diseases
PubMed: 31637220
DOI: 10.3389/fcimb.2019.00339 -
BMC Medical Imaging Apr 2023Multi slice computed tomography (MSCT) is the most common used method in middle ear imaging. However, MSCT lacks the ability to distinguish the ossicular chain...
Assessment of subjective image quality, contrast to noise ratio and modulation transfer function in the middle ear using a novel full body cone beam computed tomography device.
BACKGROUND
Multi slice computed tomography (MSCT) is the most common used method in middle ear imaging. However, MSCT lacks the ability to distinguish the ossicular chain microstructures in detail resulting in poorer diagnostic outcomes. Novel cone beam computed tomography (CBCT) devices' image resolution is, on the other hand, better than MSCT resolution. The aim of this study was to optimize imaging parameters of a novel full body CBCT device to obtain optimal contrast to noise ratio (CNR) with low effective dose, and to optimize its clinical usability.
METHODS
Imaging of five anonymous excised human cadaver temporal bones, the acquisition of the effective doses and the CNR measurements were performed for images acquired on using Planmed XFI® full body CBCT device (Planmed Oy, Helsinki, Finland) with a voxel size of 75 µm. All images acquired from the specimens using 10 different imaging protocols varying from their tube current exposure time product (mAs) and tube voltage (kVp) were analyzed for eight anatomical landmarks and evaluated by three evaluators.
RESULTS
With the exception of protocol with 90 kVp 100 mAs, all other protocols used are competent to image the finest structures. With a moderate effective dose (86.5 µSv), protocol with 90 kV 450 mAs was chosen the best protocol used in this study. A significant correlation between CNR and clinical image quality of the protocols was observed in linear regression model. Using the optimized imaging parameters, we were able to distinguish even the most delicate middle ear structures in 2D images and produce accurate 3D reconstructions.
CONCLUSIONS
In this ex vivo experiment, the new Planmed XFI® full body CBCT device produced excellent 2D resolution and easily created 3D reconstructions in middle ear imaging with moderate effective doses. This device would be suitable for middle ear diagnostics and for e.g., preoperative planning. Furthermore, the results of this study can be used to optimize the effective dose by selecting appropriate exposure parameters depending on the diagnostic task.
Topics: Humans; Radiation Dosage; Phantoms, Imaging; Cone-Beam Computed Tomography; Tomography, X-Ray Computed; Ear, Middle
PubMed: 37038130
DOI: 10.1186/s12880-023-00996-6 -
Journal of the Association For Research... Dec 2019The effects of middle-ear pathology on wideband acoustic immittance and reflectance at frequencies above 6-8 kHz have not been documented, nor has the effect of such...
The effects of middle-ear pathology on wideband acoustic immittance and reflectance at frequencies above 6-8 kHz have not been documented, nor has the effect of such pathologies on the time-domain reflectance. We describe an approach that utilizes sound frequencies as high as 20 kHz and quantifies reflectance in both the frequency and time domains. Experiments were performed with fresh normal human temporal bones before and after simulating various middle-ear pathologies, including malleus fixation, stapes fixation, and disarticulation. In addition to experimental data, computational modeling was used to obtain fitted parameter values of middle-ear elements that vary systematically due to the simulated pathologies and thus may have diagnostic implications. Our results demonstrate that the time-domain reflectance, which requires acoustic measurements at high frequencies, varies with middle-ear condition. Furthermore, the extended bandwidth frequency-domain reflectance data was used to estimate parameters in a simple model of the ear canal and middle ear that separates three major conductive pathologies from each other and from the normal state.
Topics: Acoustic Impedance Tests; Acoustic Stimulation; Computer Simulation; Ear Canal; Ear, Middle; Humans; Temporal Bone
PubMed: 31673928
DOI: 10.1007/s10162-019-00735-1 -
BMC Surgery Jun 2023This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
OBJECTIVE(S)
This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.
METHODS
The clinical records of children diagnosed with CG were retrospectively reviewed.
RESULTS
The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months.
CONCLUSION(S)
The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.
Topics: Humans; Child; Retrospective Studies; Tympanic Membrane; Ear, Middle; Granuloma; Cholesterol
PubMed: 37312115
DOI: 10.1186/s12893-023-02069-5 -
Hearing Research Jun 2021The human tympanic membrane (TM) and ossicles are generally considered to act as a linear system as they conduct low and moderate level environmental sounds to the...
The human tympanic membrane (TM) and ossicles are generally considered to act as a linear system as they conduct low and moderate level environmental sounds to the cochlea. At intense stimulus levels (> 120 dB SPL) there is evidence that the TM and ossicles no longer act linearly. The anatomical structures that contribute to the nonlinear responses and their level and frequency dependences are not well defined. We used cadaveric human ears to characterize middle-ear responses to continuous tones between 200 and 20,000 Hz with levels between 60 and 150 dB SPL. The responses of the TM and ossicles are essentially sinusoidal, even at the highest stimulus level, but grow nonlinearly with increased stimulus level. The umbo and the stapes show different nonlinear behaviors: The umbo displacement grows faster than the stimulus level (expansive growth) at frequencies below 2000 Hz, while the stapes exhibits mostly compressive growth (grows slower than the stimulus level) over a wide frequency range. The sound pressure level where the nonlinearity first becomes obvious and the displacement at that level are lower at the stapes than at the umbo. These observations suggest the presence of multiple nonlinear processes within the middle ear. The existence of an expansive growth of umbo displacement that has limited effect on the stapes compressive growth suggests that the ossicular joints reduce the coupling between multiple nonlinear mechanisms within the middle ear. This study provides new data to test and refine middle-ear nonlinear models.
Topics: Ear, Middle; Humans; Ossicular Prosthesis; Sound; Stapes; Tympanic Membrane; Vibration
PubMed: 33872835
DOI: 10.1016/j.heares.2021.108242 -
Head and Neck Pathology Jun 2022Viral infections have already been implicated with otitis media and sudden sensorineural hearing loss. However, the pathophysiology of COVID-19 as it relates to otologic...
Viral infections have already been implicated with otitis media and sudden sensorineural hearing loss. However, the pathophysiology of COVID-19 as it relates to otologic disorders is not well-defined. With the spread of SARS-CoV-2, it is important to evaluate its colonization of middle ear mucosa. Middle ear and nasal tissue samples for quantitative RT-PCR and histologic evaluations were obtained from post-mortem COVID-19 patients and non-diseased control patients. Here we present evidence that SARS-CoV-2 colonizes the middle ear epithelium and co-localizes with the primary viral receptor, angiotensin-converting enzyme 2 (ACE2). Both middle ear and nasal epithelial cells show relatively high expression of ACE2, required for SARS-CoV-2 entry. The epithelial cell adhesion molecule (EpCAM) was use as a biomarker of epithelia. Furthermore, we found that the viral load in the middle ear is lower than that present in the nasal cavity.
Topics: Angiotensin-Converting Enzyme 2; COVID-19; Ear, Middle; Humans; Nasal Cavity; SARS-CoV-2
PubMed: 34455569
DOI: 10.1007/s12105-021-01378-6