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The Laryngoscope Mar 2024To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide... (Review)
Review
OBJECTIVE
To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management.
DATA SOURCES
PubMed, Embase, Cochrane Library.
REVIEW METHODS
Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre- and post-treatment audiograms, and imaging were obtained. Systematic review of the literature was performed.
RESULTS
Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4 months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air-bone gap (ABG) at initial presentation ranged from 16 to 26 dB, and was greater at higher frequencies. Thirty-six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (p < 0.05), while not at any frequency for those who were observed.
CONCLUSIONS
Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. Laryngoscope, 134:1032-1041, 2024.
Topics: Humans; Malleus; Hearing Loss, Conductive; Retrospective Studies; Hearing; Hearing Tests; Fractures, Bone; Treatment Outcome
PubMed: 37584374
DOI: 10.1002/lary.30962 -
Anatomical Record (Hoboken, N.J. : 2007) Nov 2023The placental order Dermoptera, which includes two extant species, the Philippine and Sunda flying lemurs, Cynocephalus volans and Galeopterus variegatus, respectively,...
The placental order Dermoptera, which includes two extant species, the Philippine and Sunda flying lemurs, Cynocephalus volans and Galeopterus variegatus, respectively, is generally held to be the sister group of Primates. Yet, little has been reported on their cranial anatomy. Here, the anatomy of the ear region is described and illustrated for a juvenile and adult C. volans based on CT scans. The inclusion of a juvenile is essential as nearly all cranial sutures are fused in the adult. Soft tissues are reconstructed based on sectioned histological pre- and postnatal specimens previously reported by the author. Numerous unusual features are identified, including: a small parasphenoid beneath the basisphenoid, a tensor tympani fossa on the epitympanic wing of the squamosal, a cavum supracochleare for the geniculate ganglion of the facial nerve that is not enclosed in the petrosal bone, a secondary facial foramen between the petrosal and squamosal, a secondary posttemporal foramen leading to the primary one, a subarcuate fossa that is floored in part by a large contribution from the squamosal, a body of the incus larger than the head of the malleus, and a crus longum of the incus that lacks an osseous connection to the lenticular process. Documentation of the anatomy of the Philippine flying lemur ear region is an essential first step in morphological phylogenetic analyses where features of the basicranium are widely sampled.
Topics: Pregnancy; Animals; Female; Phylogeny; Lemur; Philippines; Placenta; Primates; Chiroptera
PubMed: 36897245
DOI: 10.1002/ar.25174 -
Indian Journal of Otolaryngology and... Dec 2023The temporal bone is a complex anatomical space that houses the middle ear and its ossicles, as well as the inner ear, which includes the vestibule, cochlea, and the...
The temporal bone is a complex anatomical space that houses the middle ear and its ossicles, as well as the inner ear, which includes the vestibule, cochlea, and the semicircular canals. Henle's spine, also known as the suprameatal spine/spina suprameatica/ is found to guide the lateral wall of the mastoid antrum [J Res Med Dent Sci 8(7):420-422, Stat-Pearls Publishing, Treasure Island. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559153/]. It is found that the Henle's spine is present in 85% of the human skulls and when present, it could be used as a reliable anatomical landmark for isolating various foramina during skull base surgeries [J Laryngol Otol 119:856-861], and to assess the location of handle of malleus and subsequently the mastoid antrum, in many cases. We present here 3 cases in which tympanoplasty was planned, and the position of spine of Henle was found to be anterosuperior and so was the handle of malleus. Antrostomy was done by following the spine of Henle in all cases to establish patency and maintain ventilation in the post-operative ear. These 3 cases had a much more anteriorly placed spine. Such cases need to be reported so that it creates a paradigm shift in the way that mastoid surgeries are being done. Any variation in the positioning of the spine of henle points to variability in the position of the mastoid antrum. This is extremely important while drilling the mastoid in the correct position and also to prevent drilling over the sigmoid sinus or the dura. To conclude, an anteriorly placed spine of Henle corresponds to anteriorly placed mastoid antrum.
PubMed: 37974806
DOI: 10.1007/s12070-023-04017-4 -
Medicina (Kaunas, Lithuania) Sep 2023: The diagnosis of cholesteatoma is usually clinic, and the only efficient treatment is surgical. High-resolution computed tomography (HRCT) is not considered absolutely...
: The diagnosis of cholesteatoma is usually clinic, and the only efficient treatment is surgical. High-resolution computed tomography (HRCT) is not considered absolutely necessary for the management of an uncomplicated cholesteatoma, but unsuspected situations from a clinical point of view can be discovered using the scans, warning the surgeon. Our objective is to compare HRCT scan information with intraoperative findings in patients with cholesteatoma and analyze the usefulness of a preoperative HRCT scan from a surgical point of view. : This is a prospective descriptive study conducted in the Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Romania, from May 2021 to April 2022. It was carried out on 46 patients with a clinical diagnosis of cholesteatoma who were consequently operated on in our department. All patients received full clinical and audiological examinations. In all cases, an HRCT scan was performed preoperatively as a mandatory investigation. Preoperative HRCT scans were analyzed, and their findings were compared to the intraoperative notes. The two sets of observations were analyzed using standard statistical methods. : Extensive cholesteatoma was the most common type of disease, involving 46% of the patients, followed by pars flaccida cholesteatoma (35%) and pars tensa cholesteatoma (19%). Eroded scutum was the most frequent lesion involving 70% of the patients, followed by incus erosion (67%). Comparison of the HRCT and intraoperative findings revealed a very good correlation for tegmen tympani erosion, sigmoid plate erosion, scutum and malleus erosion, and a moderate-to-good correlation for lateral semicircular canal erosion, incus and stapes erosion, and fallopian canal erosion. : HRCT is a valuable tool in the preoperative assessment of cholesteatoma, helping in making surgical decisions. It can accurately predict the extent of disease and is helpful for detecting unapparent dangerous situations. However, it is not very accurate in detecting fallopian canal and stapes erosion.
Topics: Humans; Cholesteatoma, Middle Ear; Ear, Middle; Tomography, X-Ray Computed; Prospective Studies; Ambulatory Care Facilities; Retrospective Studies
PubMed: 37893430
DOI: 10.3390/medicina59101712 -
Anatomical Record (Hoboken, N.J. : 2007) Nov 2023Echolocation is the primary sense used by most bats to navigate their environment. However, the influence of echolocating behaviors upon the morphology of the auditory...
Echolocation is the primary sense used by most bats to navigate their environment. However, the influence of echolocating behaviors upon the morphology of the auditory apparatus remains largely uninvestigated. While it is known that middle ear ossicle size scales positively with body mass across mammals, and that peak call frequency scales negatively with body mass among bats, there are still large gaps in our understanding of the degree to which allometry or ecology influences the morphology of the chiropteran auditory apparatus. To investigate this, we used μCT datasets to quantify three morphological components of the inner and middle ear: ossicle size, ossicle shape, and cochlear spirality. These data were collected across 27 phyllostomid species, spanning a broad range of body sizes, habitats, and dietary categories, and the relationships between these variables and ear morphology were assessed using a comparative phylogenetic approach. Ossicle size consistently scaled with strong negative allometry relative to body mass. Cochlear spirality was significantly (p = .025) associated with wing aspect ratio (a proxy for habitat use) but was not associated with body mass. From a morphological perspective, the malleus and incus exhibited some variation in kind with diet and call frequency, while stapes morphology is more closely tied to body size. Future work will assess these relationships within other chiropteran lineages, and investigate potential morphological differences in the middle and inner ear of echolocating-vs-non-echolocating taxa.
Topics: Animals; Phylogeny; Chiroptera; Ear, Inner; Echolocation; Incus
PubMed: 36823766
DOI: 10.1002/ar.25178 -
Indian Journal of Otolaryngology and... Sep 2023Previous studies of the middle ear in Chronic Otitis Media have focussed on radiological assessment of temporal bone; endoscopic studies were focussed on perforation...
UNLABELLED
Previous studies of the middle ear in Chronic Otitis Media have focussed on radiological assessment of temporal bone; endoscopic studies were focussed on perforation size and location. The malleus handle (manubrium) is a constant ossicular feature visible on otoendoscopy. It's relative position may indicate the previously documented differences in ossicular chain and middle ear cleft development relative to the tympanic ring and inner ear capsule between affected ear and contralateral ear.
DESIGN
descriptive.
SETTING
hospital based.
SUBJECTS
84 patients with unilateral mucosal chronic otitis media.
METHODS
each patient underwent Otoendoscopy and the findings were recorded through a camera connected to a laptop. Using image j software these images were analysed. Participants were of mean age of 35 years with left preponderance, and no gender preponderance was found. In our study, majority of the perforations were small sized perforations. The malleus handle foreshortening was about 92.6% compared to unaffected ear which was statistically insignificant. There was a significant inter group difference in the distance between the tip of the manubrium and the inferior annulus-which was decreased in affected ears and in the distance from the lateral process to the anterior tympanic ring-which was increased in affected ears. There was no difference in the malleo scutal angles. These differences were not dependent on the site or size of the perforation. The differences we found between ears were unexpected. The significance of the differences in the shape of the tympanic membrane between affected and unaffected ears in unilateral mucosal COM need further study. We did not find a statistically significant difference in the malleo-scutal angles between ears.
PubMed: 37636676
DOI: 10.1007/s12070-023-03797-z -
Anatomia, Histologia, Embryologia Jan 2024It is important to know the morphometry of the auditory ossicles for middle ear surgical applications. The present study aims to investigate the morphometric...
It is important to know the morphometry of the auditory ossicles for middle ear surgical applications. The present study aims to investigate the morphometric measurements of sheep auditory ossicles and the relationship between these ossicles. In this study, 100 malleus, incus and stapes of 50 Akkaraman sheep were examined using at trinocular stereo microscope and a total of 19 morphometric measurements were taken. The mean values of the morphometric measurements were obtained, and correlation analysis was performed between each part of each auditory ossicle. Similarities were found between the measurements of the lengths of the malleus, manubrium mallei and incus, and the width of the base of the stapes with morphometric measurements in human auditory ossicles. A significant positive correlation was found between the length of the malleus with the length of the manubrium mallei, between the length of the incus with the lengths of the long crus and corpus incudis, between the length of the stapes with the lengths of the rostral crus, caudal crus, caput stapedis, and the length and width of the intercrural foramen. Due to the anatomic similarities between sheep and human auditory ossicles, it was concluded that the auditory ossicles of sheep are suitable for use in the training of human ear surgery applications.
Topics: Humans; Animals; Sheep; Ear Ossicles; Ear, Middle; Incus; Stapes; Malleus
PubMed: 37985461
DOI: 10.1111/ahe.12998 -
BioRxiv : the Preprint Server For... Jan 2024How we move our bodies affects how we perceive sound. For instance, we can explore an environment to seek out the source of a sound and we can use head movements to...
How we move our bodies affects how we perceive sound. For instance, we can explore an environment to seek out the source of a sound and we can use head movements to compensate for hearing loss. How we do this is not well understood because many auditory experiments are designed to limit head and body movements. To study the role of movement in hearing, we developed a behavioral task called sound-seeking that rewarded mice for tracking down an ongoing sound source. Over the course of learning, mice more efficiently navigated to the sound. We then asked how auditory behavior was affected by hearing loss induced by surgical removal of the malleus from the middle ear. An innate behavior, the auditory startle response, was abolished by bilateral hearing loss and unaffected by unilateral hearing loss. Similarly, performance on the sound-seeking task drastically declined after bilateral hearing loss and did not recover. In striking contrast, mice with unilateral hearing loss were only transiently impaired on sound-seeking; over a recovery period of about a week, they regained high levels of performance, increasingly reliant on a different spatial sampling strategy. Thus, even in the face of permanent unilateral damage to the peripheral auditory system, mice recover their ability to perform a naturalistic sound-seeking task. This paradigm provides an opportunity to examine how body movement enables better hearing and resilient adaptation to sensory deprivation.
PubMed: 38260458
DOI: 10.1101/2024.01.08.574475 -
International Journal of Pediatric... Apr 2024Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR...
INTRODUCTION
Endoscopic ossicular chain reconstruction (OCR) in adults has demonstrated equivalent outcomes to the traditional microscopic approach. Less data exist on endoscopic OCR outcomes in children, who have unique considerations including a smaller transcanal corridor and variable pathology. The purpose of this study was to investigate surgical and audiometric outcomes in children undergoing fully endoscopic and endoscopic-assisted OCR in both the short and long-term.
METHODS
Retrospective review of all children (<17 years) who underwent endoscopic OCR at one tertiary care center between 2017 and 2021. Children undergoing primary and revision endoscopic OCR with either partial (PORP) and total ossicular reconstruction prostheses (TORP) were included. Children undergoing surgery for juvenile otosclerosis or congenital stapes fixation, or any child receiving a stapes prosthesis were excluded. Primary outcome measures were post-operative change in 4 frequency (500 Hz, 1, 2, 4 KHz) air conduction pure tone average (AC PTA) and change in air-bone gap (ABG). Secondary measures included need for readmission and/or revision surgery, complication rate, and surgery duration.
RESULTS
Seventeen patients met inclusion criteria. Average age was 11.3 years (range, 5-17 years); 14 were male. A variety of fixed length, titanium total and partial prostheses were used. The most common prosthesis length was 2 mm (range 2-5 mm), and there were no intra- or perioperative complications. Mean long-term follow-up was 2.6 years. Most common pathology was congenital cholesteatoma (11/17, 64%), followed by chronic otitis media with tympanic membrane perforation (5/17, 29.4%), and extruded prosthesis (1/17, 5.9%). Intraoperatively, the most common finding was incus erosion (10/17, 58.8%), followed by malleus erosion (6/17, 35.3%), stapes erosion (4/17, 23.5%), and stapes absence (4/17, 23.5%). Eight children (47%) were reconstructed with PORPs, and 9 children (52.9%) were reconstructed with TORPs. Average ABG improved from 36.8 dB preoperatively to 19.9 dB postoperatively in the short-term and remained stable at 19.5 dB in the long-term. Average short-term ABG improvement was 4.2 dB for PORPs and 18 dB for TORPs. In the long-term, average ABG improved by 2.3 dB in PORPs and 13.4 dB in TORPs. PORPs had higher rates of ABG closure and lower AC PTAs than TORPs in the long-term.
DISCUSSION
Endoscopic ossiculoplasty is a viable option in children presenting with ossicular erosion from various causes. Audiometric improvement following endoscopic partial and total ossicular reconstruction remains stable over time, with a preference towards partial in the long-term, and mirrors published outcomes for microscopic surgery.
Topics: Adult; Humans; Male; Child; Female; Titanium; Ossicular Replacement; Ossicular Prosthesis; Prosthesis Implantation; Ear, Middle; Retrospective Studies; Treatment Outcome
PubMed: 38579403
DOI: 10.1016/j.ijporl.2024.111938 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Oct 2023For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. From June 2017 to June 2019, 147...
For tympanosclerosis patients with ossicular chain fixation, we use ossicular chain bypass technique and evaluate its long-term effects. From June 2017 to June 2019, 147 patients with tympanosclerosis who underwent middle ear surgery with otoscopy in Yinchuan First People's Hospital were reviewed. The subjects were divided into three groups according to the implemented operation plan, 51 cases in the ossicular chain mobilization group(OCM), 56 cases in the ossicular chain bypass reconstruction group(OCB), and 40 cases in the malleus-incus complex resection reconstruction group(MICR). Through a three-year follow-up, the medium and long-term effects of different operation plans were compared and analyzed. There was no significant difference among the three groups in the incidence of tympanic membrane perforation, delayed facial nerve palsy, and the dispatch and displacement of PORP. The incidence of tympanic membrane retraction pocket or cholesteatoma after operation in OCB group(0) was significantly lower than that in OCM group(11.76%) and MICR group(7.5%)(<0.05). At 12 months after operation, ΔABG of OCB group and MICR group were better than that in the OCM group(<0.05). At 36 months after operation, ΔABG of OCB group was better than that in the OCM group(<0.05), and there was no significant difference between OCB group and MICR group. The audiological performance of patients with epitympanic sclerosis(ETS) at 12, 24 and 36 months after operation was better than that of patients with posterior tympanosclerosis(PTS) and total tympanosclerosis(TTS)(<0.05). Compared with patients undergoing ossicular chain mobilization and malleus-incus complex resection for ossicular chain reconstruction, patients with tympanosclerosis undergoing bypass technique have better and stable hearing prognosis in medium and long term. This technique can effectively prevent the formation of retracted pocket and cholesteatoma in patients with tympanosclerosis after operation.
Topics: Humans; Tympanosclerosis; Ear Ossicles; Ear, Middle; Malleus; Cholesteatoma; Retrospective Studies; Ossicular Prosthesis; Treatment Outcome
PubMed: 37828886
DOI: 10.13201/j.issn.2096-7993.2023.10.010