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The Laryngoscope Jun 2024Although previous research has indicated inner ear changes in diabetes mellitus (DM) patients, no prior study has explored the middle ear, particularly the ossicles and...
OBJECTIVES
Although previous research has indicated inner ear changes in diabetes mellitus (DM) patients, no prior study has explored the middle ear, particularly the ossicles and their joints, in DM patients. This study aimed to investigate whether type 2 DM is associated with middle ear changes, specifically affecting the ossicular chain and joints.
METHODS
This study included 47 ears from 25 patients with DM (male = 13, female = 12, age: 51.0 ± 20.5) and age- and sex-matched controls (male = 10, female = 10, age: 54.8 ± 15.9) (sex; p = 1.000, Age; p = 0.991). Otopathological evaluations of the auditory ossicles and incudomalleolar joint (IMJ) were performed using light microscopy.
RESULTS
In the IMJ of DM cases, malleus hyalinized cartilage (Malleus hC) and incus hyalinized cartilage (Incus hC) were significantly increased compared with control cases (Malleus hC; DM, 34.17 ± 9.71 μm vs. control 21.96 ± 4.16 μm, p < 0.001) (Incus hC; DM 35.11 ± 10.12 μm vs. control 22.42 ± 4.368 μm, p < 0.001). In addition, bone-line distance was significantly longer than in DM cases than control cases (DM 266.72 ± 59.11 μm vs. control 239.81 ± 35.56 μm p = 0.040). On the other hand, joint discus distance was longer in the control group than in DM cases (DM 96.84 ± 36.80 μm vs. Control 113.63 ± 23.81 μm, p = 0.001).
CONCLUSIONS
This study reveals a notable increase in the hyalinized cartilage layer and bone-line distance accompanied by reducing joint discus distance within the IMJ in DM cases. These findings suggest that DM may influence microjoints, such as the IMJ, and potentially impact auditory function.
EVIDENCE LEVEL
N/A Laryngoscope, 134:2871-2878, 2024.
Topics: Humans; Female; Male; Middle Aged; Diabetes Mellitus, Type 2; Ear Ossicles; Adult; Case-Control Studies; Aged; Ear, Middle
PubMed: 38174760
DOI: 10.1002/lary.31257 -
Otology & Neurotology : Official... Mar 2024Investigating the outcomes of a surgical approach to treat isolated defects of the stapes suprastructure, using a modified total ossicular replacement prosthesis (TORP)...
OBJECTIVE
Investigating the outcomes of a surgical approach to treat isolated defects of the stapes suprastructure, using a modified total ossicular replacement prosthesis (TORP) prosthesis as a PORP between the footplate and the incus, effectively creating a TORP-PORP configuration.
PATIENTS
Eleven patients (mean age, 37.2 years; 36% male and 64% female) between the years 2007 and 2022.
INTERVENTIONS
Therapeutic (ossiculoplasty).
MAIN OUTCOME MEASURES
Hearing gain (in dB) in air conduction thresholds at 0.5, 1, 2, 3, and 4 kHz, stability of bone conduction, revision rate.
RESULTS
Significant improvement in air conduction between the preoperative and the postoperative cohorts (p = 0.002) with a mean postoperative hearing level of 30.00 ± 5.25 dB. The bone conduction remained stable. We encountered no perioperative complications, and there were no revisions surgery.
CONCLUSIONS
The described ossiculoplasty procedure is a safe and effective approach to treat isolated defects of the stapes suprastructure.
Topics: Humans; Male; Female; Adult; Ossicular Prosthesis; Stapes; Incus; Tympanoplasty; Ossicular Replacement; Treatment Outcome; Retrospective Studies; Stapes Surgery
PubMed: 38361297
DOI: 10.1097/MAO.0000000000004124 -
Medical Science Monitor : International... Jul 2023BACKGROUND We explored a new method for measuring the length of artificial stapes during stapedotomy in otoendoscopic middle-ear surgery using a flexible ruler. MATERIAL... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND We explored a new method for measuring the length of artificial stapes during stapedotomy in otoendoscopic middle-ear surgery using a flexible ruler. MATERIAL AND METHODS A retrospective analysis was conducted on 56 cases of otosclerosis, comprising 56 ears with a follow-up of over 6 months and complete data. Patients were admitted to the Department of Otology, Huazhong University of Science and Technology Union Shenzhen Hospital from July 2020 to June 2022. SPSS statistical software was used for efficacy analysis. The results of different measurement methods on the implantation time of the prosthesis and postoperative hearing follow-up were compared. RESULTS The 56 patients were randomly divided into 2 groups. In 1 case measured by the metal measuring stick, the prosthesis was too short and was replaced during the operation; 2 patients experienced transient dizziness postoperatively, and the other patients had no surgical complications. All 56 patients had varying degrees of hearing improvement after surgery, and no dislocation of the ossicular chain was observed during the follow-up. There was a statistically significant difference in the implantation time of the prosthesis between the different measurement methods (P<0.05). The improvement in hearing in the flexible ruler group was statistically significant (P<0.05). CONCLUSIONS The selection of the length of the ossicular prosthesis is a crucial step in the operation and can directly affect hearing outcomes. The use of a flexible ruler to measure prosthesis length can significantly shorten operation time and improve hearing, and the ruler is easily obtainable. It is worth promoting its application in ear endoscopic stapedotomy.
Topics: Humans; Stapes; Ossicular Prosthesis; Retrospective Studies; Prosthesis Implantation; Artificial Limbs
PubMed: 37480226
DOI: 10.12659/MSM.940337 -
Otolaryngology--head and Neck Surgery :... Oct 2023Preoperative planning for otologic or neurotologic procedures often requires manual segmentation of relevant structures, which can be tedious and time-consuming....
OBJECTIVE
Preoperative planning for otologic or neurotologic procedures often requires manual segmentation of relevant structures, which can be tedious and time-consuming. Automated methods for segmenting multiple geometrically complex structures can not only streamline preoperative planning but also augment minimally invasive and/or robot-assisted procedures in this space. This study evaluates a state-of-the-art deep learning pipeline for semantic segmentation of temporal bone anatomy.
STUDY DESIGN
A descriptive study of a segmentation network.
SETTING
Academic institution.
METHODS
A total of 15 high-resolution cone-beam temporal bone computed tomography (CT) data sets were included in this study. All images were co-registered, with relevant anatomical structures (eg, ossicles, inner ear, facial nerve, chorda tympani, bony labyrinth) manually segmented. Predicted segmentations from no new U-Net (nnU-Net), an open-source 3-dimensional semantic segmentation neural network, were compared against ground-truth segmentations using modified Hausdorff distances (mHD) and Dice scores.
RESULTS
Fivefold cross-validation with nnU-Net between predicted and ground-truth labels were as follows: malleus (mHD: 0.044 ± 0.024 mm, dice: 0.914 ± 0.035), incus (mHD: 0.051 ± 0.027 mm, dice: 0.916 ± 0.034), stapes (mHD: 0.147 ± 0.113 mm, dice: 0.560 ± 0.106), bony labyrinth (mHD: 0.038 ± 0.031 mm, dice: 0.952 ± 0.017), and facial nerve (mHD: 0.139 ± 0.072 mm, dice: 0.862 ± 0.039). Comparison against atlas-based segmentation propagation showed significantly higher Dice scores for all structures (p < .05).
CONCLUSION
Using an open-source deep learning pipeline, we demonstrate consistently submillimeter accuracy for semantic CT segmentation of temporal bone anatomy compared to hand-segmented labels. This pipeline has the potential to greatly improve preoperative planning workflows for a variety of otologic and neurotologic procedures and augment existing image guidance and robot-assisted systems for the temporal bone.
Topics: Humans; Deep Learning; Ear, Inner; Temporal Bone; Cone-Beam Computed Tomography; Tomography, X-Ray Computed; Image Processing, Computer-Assisted
PubMed: 36883992
DOI: 10.1002/ohn.317 -
Otology & Neurotology : Official... Oct 2023After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents.
STUDY DESIGN
Multicenter randomized prospective international study.
SETTING
Four academic institutions.
METHODS
Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales.
RESULTS
A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores ( p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture.
CONCLUSION
Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.
Topics: Humans; Prospective Studies; Reproducibility of Results; Ear, Middle; Stapes; Ossicular Prosthesis
PubMed: 37590880
DOI: 10.1097/MAO.0000000000003998 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2024To compare the application of endoscope and microscope in all kinds of stapes surgeries. Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in...
To compare the application of endoscope and microscope in all kinds of stapes surgeries. Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School. Hearing level, hospital stay post-operation, times of hospital visit post-operation, etc. have been compared between the endoscopic group and microscopic group. Patients who were failed to place the stapes prosthesis because of the poor exposure of the oval window have been analyzed. Otosclerosis was the most common diagnosis in both groups. There was 1(1/23) middle ear malformation in the endoscopic group and 5(5/36) middle ear malformations in the microscopic group. There were 2 Van Der Hover syndromes and 4 Treacher Collins syndromes in the microscopic group. In the endoscopic group ABG of 10 ears(43.5%) ≤ 10 dB, and ABG of 21 ears(91.3%) ≤20 dB.In the microscopic group ABG of 13 ears(41.9%) ≤ 10 dB, and ABG of 28 ears(90.3%) ≤ 20 dB. There was no statistic difference between 2 groups. Times of hospital visit post-operation in the endoscopic group was less than in the microscopic group(<0.01). There was no facial palsy, tympanic perforation or profound sensorineural hearing loss in both groups. Endoscope is more suitable for patients who are evaluated with no severe stapes malformation, or less manipulation of drilling the bone. It could also reduce the hospital visit post-operation. Patients with narrow ear canal or severe middle ear malformation are recommended to perform the surgery with microscope, because it provides the chance of manipulation with 2-hands of surgeons.
Topics: Humans; Stapes Surgery; Stapes; Ear, Middle; Otosclerosis; Endoscopes; Polyesters; Retrospective Studies; Treatment Outcome
PubMed: 38297862
DOI: 10.13201/j.issn.2096-7993.2024.02.005 -
Journal of Anatomy Apr 2024Although domestic dogs vary considerably in both body size and skull morphology, behavioural audiograms have previously been found to be similar in breeds as distinct as...
Although domestic dogs vary considerably in both body size and skull morphology, behavioural audiograms have previously been found to be similar in breeds as distinct as a Chihuahua and a St Bernard. In this study, we created micro-CT reconstructions of the middle ears and bony labyrinths from the skulls of 17 dog breeds, including both Chihuahua and St Bernard, plus a mongrel and a wolf. From these reconstructions, we measured middle ear cavity and ossicular volumes, eardrum and stapes footplate areas and bony labyrinth volumes. All of these ear structures scaled with skull size with negative allometry and generally correlated better with condylobasal length than with maximum or interaural skull widths. Larger dogs have larger ear structures in absolute terms: the volume of the St Bernard's middle ear cavity was 14 times that of the Chihuahua. The middle and inner ears are otherwise very similar in morphology, the ossicular structure being particularly well-conserved across breeds. The expectation that larger ear structures in larger dogs would translate into hearing ranges shifted towards lower frequencies is not consistent with the existing audiogram data. Assuming that the audiograms accurately reflect the hearing of the breeds in question, oversimplifications in existing models of middle ear function or limitations imposed by other parts of the auditory system may be responsible for this paradox.
PubMed: 38605539
DOI: 10.1111/joa.14049 -
Diagnostic and Interventional Imaging Jun 2024The purpose of this study was to evaluate the ability of ultra-high-resolution computed tomography (UHR-CT) to assess stapes and chorda tympani nerve anatomy using a... (Comparative Study)
Comparative Study
PURPOSE
The purpose of this study was to evaluate the ability of ultra-high-resolution computed tomography (UHR-CT) to assess stapes and chorda tympani nerve anatomy using a deep learning (DLR), a model-based, and a hybrid iterative reconstruction algorithm compared to simulated conventional CT.
MATERIALS AND METHODS
CT acquisitions were performed with a Mercury 4.0 phantom. Images were acquired with a 1024 × 1024 matrix and a 0.25 mm slice thickness and reconstructed using DLR, model-based, and hybrid iterative reconstruction algorithms. To simulate conventional CT, images were also reconstructed with a 512 × 512 matrix and a 0.5 mm slice thickness. Spatial resolution, noise power spectrum, and objective high-contrast detectability were compared. Three radiologists evaluated the clinical acceptability of these algorithms by assessing the thickness and image quality of the stapes footplate and superstructure elements, as well as the image quality of the chorda tympani nerve bony and tympanic segments using a 5-point confidence scale on 13 temporal bone CT examinations reconstructed with the four algorithms.
RESULTS
UHR-CT provided higher spatial resolution than simulated conventional CT at the penalty of higher noise. DLR and model-based iterative reconstruction provided better noise reduction than hybrid iterative reconstruction, and DLR had the highest detectability index, regardless of the dose level. All stapedial structure thicknesses were thinner using UHR-CT by comparison with conventional simulated CT (P < 0.009). DLR showed the best visualization scores compared to the other reconstruction algorithms (P < 0.032).
CONCLUSION
UHR-CT with DLR results in less noise than UHR-CT with hybrid iterative reconstruction and significantly improves stapes and tympanic chorda tympani nerve depiction compared to simulated conventional CT and UHR-CT with iterative reconstruction.
Topics: Deep Learning; Temporal Bone; Humans; Tomography, X-Ray Computed; Phantoms, Imaging; Stapes; Chorda Tympani Nerve; Algorithms; Image Processing, Computer-Assisted
PubMed: 38368178
DOI: 10.1016/j.diii.2024.02.001 -
Advanced Science (Weinheim,... Apr 2024This paper presents an acoustic transducer for fully implantable cochlear implants (FICIs), which can be implanted on the hearing chain to detect and filter the ambient...
This paper presents an acoustic transducer for fully implantable cochlear implants (FICIs), which can be implanted on the hearing chain to detect and filter the ambient sound in eight frequency bands between 250 and 6000 Hz. The transducer dimensions are conventional surgery compatible. The structure is formed with 3 × 3 × 0.36 mm active space for each layer and 5.2 mg total active mass excluding packaging. Characterization of the transducer is carried on an artificial membrane whose vibration characteristic is similar to the umbo vibration. On the artificial membrane, piezoelectric transducer generates up to 320.3 mV under 100 dB sound pressure level (SPL) excitation and covers the audible acoustic frequency. The measured signal-to-noise-ratio (SNR) of the channels is up to 84.2 dB. Sound quality of the transducer for fully implantable cochlear implant application is graded with an objective qualification method (PESQ) for the first time in the literature to the best of the knowledge, and scored 3.42/4.5.
Topics: Vibration; Transducers; Cochlear Implants; Humans; Equipment Design; Signal-To-Noise Ratio; Acoustics; Ear Ossicles; Prosthesis Design
PubMed: 38380504
DOI: 10.1002/advs.202308277 -
Japanese Journal of Radiology Jan 2024Imaging diagnosis of stapes fixation (SF) is challenging owing to a lack of definite evidence. We developed a comprehensive machine learning (ML) model to identify SF on...
PURPOSE
Imaging diagnosis of stapes fixation (SF) is challenging owing to a lack of definite evidence. We developed a comprehensive machine learning (ML) model to identify SF on ultra-high-resolution CT.
MATERIALS AND METHODS
We retrospectively enrolled 109 participants (143 ears) and divided them into the training set (115 ears) and test set (28 ears). Stapes mobility (SF or non-SF) was determined by surgical inspection. In the ML analysis, rectangular regions of interest were placed on consecutive axial slices in the training set. Radiomic features were extracted and fed into the training session. The test set was analyzed using 7 ML models (support vector machine, k nearest neighbor, decision tree, random forest, extra trees, eXtreme Gradient Boosting, and Light Gradient Boosting Machine) and by 2 dedicated neuroradiologists. Diagnostic performance (sensitivity, specificity and accuracy, with surgical findings as the reference) was compared between the radiologists and the optimal ML model by using the McNemar test.
RESULTS
The mean age of the participants was 42.3 ± 17.5 years. The Light Gradient Boosting Machine (LightGBM) model showed the highest sensitivity (0.83), specificity (0.81), accuracy (0.82) and area under the curve (0.88) for detecting SF among the 7 ML models. The neuroradiologists achieved good sensitivities (0.75 and 0.67), moderate-to-good specificities (0.63 and 0.56) and good accuracies (0.68 and 0.61). This model showed no statistical differences with the neuroradiologists (P values 0.289-1.000).
CONCLUSIONS
Compared to the neuroradiologists, the LightGBM model achieved competitive diagnostic performance in identifying SF, and has the potential to be a supportive tool in clinical practice.
Topics: Humans; Young Adult; Adult; Middle Aged; Retrospective Studies; Stapes; Machine Learning; Radiologists; Tomography, X-Ray Computed
PubMed: 37561264
DOI: 10.1007/s11604-023-01475-2