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The British Journal of Radiology Jan 2020The retrotympanic anatomy is complex and variable but has received little attention in the radiological literature. With advances in CT technology and the application of... (Review)
Review
The retrotympanic anatomy is complex and variable but has received little attention in the radiological literature. With advances in CT technology and the application of cone beam CT to temporal bone imaging, there is now a detailed depiction of the retrotympanic bony structures.With the increasing use of endoscopes in middle ear surgery, it is important for the radiologist to appreciate the nomenclature of the retrotympanic compartments in order to aid communication with the surgeon. For instance, in the context of cholesteatoma, clear imaging descriptions of retrotympanic variability and pathological involvement are valuable in pre-operative planning.The endoscopic anatomy has recently been described and the variants classified. The retrotympanum is divided into medial and lateral compartments with multiple described potential sinuses separated by bony crests.This pictorial review will describe the complex anatomy and variants of the retrotympanum. We will describe optimum reformatting techniques to demonstrate the structures of the retrotympanum and illustrate the associated anatomical landmarks and variants with CT. The implications of anatomical variants with regards to otologic surgery will be discussed.
Topics: Anatomic Landmarks; Cholesteatoma, Middle Ear; Cone-Beam Computed Tomography; Ear, Middle; Humans; Otoscopy; Tomography, X-Ray Computed; Tympanic Membrane
PubMed: 31593485
DOI: 10.1259/bjr.20190677 -
The Journal of International Advanced... Apr 2019An ameloblastoma is a locally aggressive odontogenic tumour that commonly develops from the odontogenic epithelium within the jawbone. Here we present for the first time...
An ameloblastoma is a locally aggressive odontogenic tumour that commonly develops from the odontogenic epithelium within the jawbone. Here we present for the first time a case of a rare primary ameloblastoma in the middle ear cavity, along with some consideration of its treatment and a new classification. A 65-year-old woman presented with a left middle ear cavity tumour. Pathological examination led to the diagnosis of an ameloblastoma. We resected the tumour along with an extensive part of the middle ear mucosa, which made it difficult to have an adequate margin. It is recommended that the remaining bone be ground 2-3 mm beyond the visible margin after resecting the gross tumour. Therefore, several cases are treated with conservative surgery, including physicochemical treatment. This factor should be considered when designing treatment strategies as good alternatives in cases where resection with an adequate margin is difficult.
Topics: Aftercare; Aged; Ameloblastoma; Audiometry, Pure-Tone; Biopsy; Ear, Middle; Female; Hearing Loss, Conductive; Humans; Incus; Margins of Excision; Mastoid; Positron-Emission Tomography; Tomography, X-Ray Computed; Treatment Outcome; Tympanic Membrane
PubMed: 30924778
DOI: 10.5152/iao.2019.5433 -
European Archives of... Oct 2023To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round... (Review)
Review
OBJECTIVE
To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia.
DATA SOURCES
Pubmed/Medline, Embase and Cochrane library.
REVIEW METHODS
Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss.
RESULTS
Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and - 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0-33.3% of ears, and recurrence of hearing loss occurred in 0-66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss.
CONCLUSION
Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL.
LEVEL OF EVIDENCE
2c.
Topics: Humans; Ear Ossicles; Ear, Middle; Ear; Treatment Outcome; Hearing Loss, Conductive; Deafness; Retrospective Studies; Ossicular Prosthesis
PubMed: 37410147
DOI: 10.1007/s00405-023-08091-w -
Proceedings of the National Academy of... Oct 2016The diminutive middle ear ossicles (malleus, incus, stapes) housed in the tympanic cavity of the temporal bone play an important role in audition. The few known ossicles...
The diminutive middle ear ossicles (malleus, incus, stapes) housed in the tympanic cavity of the temporal bone play an important role in audition. The few known ossicles of Neandertals are distinctly different from those of anatomically modern humans (AMHs), despite the close relationship between both human species. Although not mutually exclusive, these differences may affect hearing capacity or could reflect covariation with the surrounding temporal bone. Until now, detailed comparisons were hampered by the small sample of Neandertal ossicles and the unavailability of methods combining analyses of ossicles with surrounding structures. Here, we present an analysis of the largest sample of Neandertal ossicles to date, including many previously unknown specimens, covering a wide geographic and temporal range. Microcomputed tomography scans and 3D geometric morphometrics were used to quantify shape and functional properties of the ossicles and the tympanic cavity and make comparisons with recent and extinct AMHs as well as African apes. We find striking morphological differences between ossicles of AMHs and Neandertals. Ossicles of both Neandertals and AMHs appear derived compared with the inferred ancestral morphology, albeit in different ways. Brain size increase evolved separately in AMHs and Neandertals, leading to differences in the tympanic cavity and, consequently, the shape and spatial configuration of the ossicles. Despite these different evolutionary trajectories, functional properties of the middle ear of AMHs and Neandertals are largely similar. The relevance of these functionally equivalent solutions is likely to conserve a similar auditory sensitivity level inherited from their last common ancestor.
Topics: Animals; Biological Evolution; Ear Ossicles; Ear, Middle; Humans; Image Processing, Computer-Assisted; Neanderthals; Principal Component Analysis
PubMed: 27671643
DOI: 10.1073/pnas.1605881113 -
JNMA; Journal of the Nepal Medical... Jun 2022Middle ear barotrauma is a tissue injury to the ear secondary to inadequate pressure equalisation between the middle ear and the external environment. Paragliding,...
INTRODUCTION
Middle ear barotrauma is a tissue injury to the ear secondary to inadequate pressure equalisation between the middle ear and the external environment. Paragliding, though an exciting sport, has its own risks and hazards. Para-pilots experience a variety of ear-related symptoms due to pressure discrepancies between the middle ear and ambient air. Middle ear barotrauma amongst para-pilots is a common yet neglected problem. The aim of this study was to find the prevalence of middle ear barotrauma among licensed para-pilots of a metropolitan city.
METHODS
A descriptive cross-sectional study was conducted amongst para-pilots practising in different paragliding companies in a metropolitan city. The study was conducted from 10th October, 2021 to 22nd October, 2021 after getting ethical approval from the Institutional Review Committee (Reference number: 0410202109/2021). A sample size of 76 participants was taken using convenience sampling technique. Data was collected from participants after performing an otoscope examination. The data were entered into Microsoft Excel version 2016 and analysed using the Statistical Package for the Social Science Version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean and standard deviation for continuous data.
RESULTS
Out of 76 participants, the prevalence of middle ear barotrauma was 10 (13.2%) (5.58-20.81 at 95% Confidence Interval).
CONCLUSIONS
The prevalence of middle ear barotrauma was similar to other studies done in similar settings.
KEYWORDS
barotrauma; eustachian tube; Nepal; pilots.
Topics: Barotrauma; Cross-Sectional Studies; Ear, Middle; Eustachian Tube; Humans; Nepal
PubMed: 35690988
DOI: 10.31729/jnma.7257 -
Head & Neck Jun 2021Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare temporal bone tumors. This study evaluates its clinical behavior and therapy outcome.
BACKGROUND
Middle ear adenomatous neuroendocrine tumors (MEANTs) are rare temporal bone tumors. This study evaluates its clinical behavior and therapy outcome.
METHOD
Retrospective case review in a tertiary referral center evaluating histopathology, immunohistochemistry, treatment, and outcome.
RESULTS
Nine patients were diagnosed with MEANT. One patient presented with locally invasive tumor and underwent extensive en-bloc tumor resection with adjuvant radiotherapy. Seven of eight patients with locally non-aggressive tumor confined to the tympanomastoid space underwent tumor resection. Two patients were disease-free, five presented recurrence, even after apparent successful surgery. All tumors showed neuroendocrine features. Histopathology and immunohistochemistry did not yield prognostic tumor characteristics.
CONCLUSION
MEANTs are rare tumors with uncertain biological behavior and subsequent unpredictable clinical course. The preferred treatment is complete surgical tumor resection. They have a high tendency for recurrence, irrespective of negative intermediary surgery. As of yet, there are no prognostic biomarkers, including histopathology and immunohistochemistry.
Topics: Ear Neoplasms; Ear, Middle; Humans; Neoplasm Recurrence, Local; Neuroendocrine Tumors; Retrospective Studies
PubMed: 33605503
DOI: 10.1002/hed.26658 -
Frontiers in Cellular and Infection... 2022Chronic otitis media (COM) is the long-term infection and inflammation of the middle ears typically caused by upper respiratory tract pathogens that are able to ascend...
Chronic otitis media (COM) is the long-term infection and inflammation of the middle ears typically caused by upper respiratory tract pathogens that are able to ascend the Eustachian tube. Our understanding of contributing factors is limited because human otopathogens cannot naturally colonize or persist in the middle ears of mice. We recently described a natural COM in mice caused by and proposed this as an experimental system to study bacterial mechanisms of immune evasion that allow persistent infection of the middle ear. Here we describe a novel pertussis toxin (PTx)-like factor unique to , apparently acquired horizontally, that is associated with its particularly efficient persistence and pathogenesis. The catalytic subunit of this toxin, PsxA, has conserved catalytic sites and substantial predicted structural homology to pertussis toxin catalytic subunit PtxA. Deletion of the gene predicted to encode the catalytic subunit, , resulted in a significant decrease in persistence in the middle ears. The defect was not observed in mice lacking T cells, indicating that PsxA is necessary for persistence only when T cells are present. These results demonstrate the role of a novel putative toxin in the persistence of and its generation of COM. This PsxA-mediated immune evasion strategy may similarly be utilized by human otopathogens, other PTx-like toxins or alternative mechanisms to disrupt critical T cell functions necessary to clear bacteria from the middle ear. This work demonstrates that this experimental system can allow for the detailed study of general strategies and specific mechanisms that otopathogens use to evade host immune responses to persist in the middle ear to cause COM.
Topics: Animals; Bacteria; Ear, Middle; Inflammation; Mice; Otitis Media; Pertussis Toxin
PubMed: 35360099
DOI: 10.3389/fcimb.2022.795230 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2021The Eustachian tube connects the middle ear and the nasopharynx. It's physiological functions include ventilating and balancing the pressure inside and outside the... (Review)
Review
The Eustachian tube connects the middle ear and the nasopharynx. It's physiological functions include ventilating and balancing the pressure inside and outside the middle ear, drainage of the middle ear secretions, prevention of retrograde infection, sound suppression and noise suppression. Eustachian tube dysfunction is closely related to the occurrence and development of many diseases. It's etiologyand influencing factors are still unclear. This article reviews the recent research on etiology and related factors of Eustachian tube dysfunction,and strives to make breakthroughs in etiology and mechanism, so as to provide help for clinical intervention.
Topics: Ear Diseases; Ear, Middle; Eustachian Tube; Humans; Nasopharynx; Otitis Media; Otitis Media with Effusion
PubMed: 34886633
DOI: 10.13201/j.issn.2096-7993.2021.12.018 -
The Journal of the Acoustical Society... May 2017The function of the middle ear (ME) in transforming ME acoustic inputs and outputs (sound pressures and volume velocities) can be described with an acoustic two-port...
The function of the middle ear (ME) in transforming ME acoustic inputs and outputs (sound pressures and volume velocities) can be described with an acoustic two-port transmission matrix. This description is independent of the load on the ME (cochlea or ear canal) and holds in either direction: forward (from ear canal to cochlea) or reverse (from cochlea to ear canal). A transmission matrix describing ME function in chinchilla, an animal commonly used in auditory research, is presented, computed from measurements of forward ME function: input admittance Y, ME pressure gain G, ME velocity transfer function H, and cochlear input admittance Y, in the same set of ears [Ravicz and Rosowski (2012b). J. Acoust. Soc. Am. 132, 2437-2454; (2013a). J. Acoust. Soc. Am. 133, 2208-2223; (2013b). J. Acoust. Soc. Am. 134, 2852-2865]. Unlike previous estimates, these computations require no assumptions about the state of the inner ear, effectiveness of ME manipulations, or measurements of sound transmission in the reverse direction. These element values are generally consistent with physical constraints and the anatomical ME "transformer ratio." Differences from a previous estimate in chinchilla [Songer and Rosowski (2007). J. Acoust. Soc. Am. 122, 932-942] may be due to a difference in ME flexibility between the two subject groups.
Topics: Acoustic Stimulation; Animals; Chinchilla; Cochlea; Computer Simulation; Ear Canal; Ear, Middle; Hearing; Models, Biological; Motion; Pressure; Sound; Time Factors
PubMed: 28599566
DOI: 10.1121/1.4982925 -
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