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Tomography (Ann Arbor, Mich.) Sep 2022The aim of this research was to assess possible relationships between petrotympanic fissure (PTF) characteristics, malleus position, and temporomandibular joint...
The aim of this research was to assess possible relationships between petrotympanic fissure (PTF) characteristics, malleus position, and temporomandibular joint disorders (TMD). A retrospective study was performed, including patients with TMD. Magnetic resonance imaging (MRI) and cone-beam computed tomography (CBCT) examination were used to evaluate temporomandibular joint (TMJ) disc position and condylar bone changes. Fifty-eight TMJs from twenty-nine patients (23:6 females: males) were assessed. Erosive changes (DDR-disc displacement with a reduction of 6 (24%), DDwR-disc displacement without a reduction of 8 (61.5%) vs. normal disc position 3 (15%), = 0.012) and condyle osteophytes production (DDR 6 (24%), DDwR 9 (69.2%) vs. normal condyle 7 (35%), = 0.012) were more frequent in subjects with disc displacement compared to normal disc position; malleus was closer to PTF in cases with erosive changes (median 2.15 interquartile range: (1.85-2.75) vs. 2.75 (2.25-3.15), = 0.029) as well as those with condylar osteophytosis (2.25 (1.91-2.75) vs. 2.75 (2.33-3.32), = 0.015); the PTF length was higher in cases with condylar osteophytosis compared to those without (4.45 (3.50-4.77) vs. 3.67 (3.34-4.28), = 0.039). The disc position and disc shape were not related to PTF or malleus position. Malleus position and PTF dimensions were not associated with the PTF type. In cases with erosive changes and condylar osteophytosis, malleus was closer to PTF.
Topics: Male; Female; Humans; Malleus; Temporomandibular Joint; Retrospective Studies; Temporomandibular Joint Disorders; Temporomandibular Joint Disc; Tongue Diseases
PubMed: 36287803
DOI: 10.3390/tomography8050204 -
The Journal of Laryngology and Otology Oct 2018To compare post-operative audiometric outcomes for the two prevailing surgical approaches for isolated malleus and/or incus fixation: ossicular mobilisation with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare post-operative audiometric outcomes for the two prevailing surgical approaches for isolated malleus and/or incus fixation: ossicular mobilisation with preservation of the ossicular chain, and disruption and reconstruction of the ossicular chain.
METHODS
A search was conducted, in December 2016, of PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature articles written in English. Papers presenting original data regarding post-operative audiometric outcomes in patients who underwent surgical treatment for malleus and/or incus fixation with a mobile and intact stapes were included. A risk of bias assessment was performed on the 14 selected papers and a tier system was developed. Meta-analysis was accomplished by comparing pooled rates of surgical success by chi-square test and calculating odds ratios by logistical regression. Analysis was performed using Revman5 and R software.Results and conclusionAnalysis of the literature revealed no differences in audiometric outcomes between ossicular chain mobilisation and ossicular chain reconstruction in patients with isolated malleus and/or incus fixation. A large, prospective study comparing both short- and long-term hearing results for ossicular chain mobilisation and ossicular chain reconstruction in this population may identify whether a difference in outcomes exists between the two approaches.
Topics: Audiometry, Pure-Tone; Ear Ossicles; Ear, Middle; Evidence-Based Medicine; Hearing; Humans; Incus; Malleus; Stapes Surgery; Tympanoplasty
PubMed: 30289092
DOI: 10.1017/S0022215118001494 -
Otolaryngologic Clinics of North America Aug 1994Ossicular chain reconstruction is most commonly performed for an absent or diseased incus. Reestablishing continuity by placing a strut prosthesis between the stapes... (Review)
Review
Ossicular chain reconstruction is most commonly performed for an absent or diseased incus. Reestablishing continuity by placing a strut prosthesis between the stapes capitulum and malleus handle minimizes the possibility of extrusion and displacement. Strut prostheses are made of hydroxyapetite, which is a highly biocompatible material that bonds to living bone.
Topics: Biocompatible Materials; Humans; Incus; Malleus; Ossicular Prosthesis; Prosthesis Design; Stapes Surgery; Treatment Outcome
PubMed: 7984370
DOI: No ID Found -
International Journal of Pediatric... Sep 2019The goal of this review was to review our series of isolated malleus fixation in pediatric patients, a rare entity causing conductive hearing loss. Malleolar fixation is...
OBJECTIVES
The goal of this review was to review our series of isolated malleus fixation in pediatric patients, a rare entity causing conductive hearing loss. Malleolar fixation is poorly described in this patient population.
METHODS
A retrospective review of pediatric tympanoplasties by the senior author over a four-year period was performed. Only cases with isolated fixation of the malleus were reviewed. Primary outcome of interest was post-operative hearing. Paired t-tests were used to calculate pre- and post-operative hearing outcomes.
RESULTS
Five cases were analyzed. Mean age at time of surgery was 9.1 years (range 4.4-16.0 years). Average follow-up after surgery was 13.9 months (range 4.4-31.2 months). Patients were otherwise healthy and typically presented after a failed school hearing test despite previously good hearing. Three out of five cases showed radiographic evidence of bony fixation (60%) on computerized tomography (CT). Otoscopy was unremarkable in all cases. Average procedure time was 41.2 min and consisted of transcanal tympanoplasty with excision of fixed bony segment. A significant improvement in both pre- and post-operative air bone gaps was observed (p = 0.005)., with average ABG of 14.75 dB.
CONCLUSIONS
Isolated pediatric malleolar fixation is an uncommon cause of pediatric conductive hearing loss. CT scan is useful for identifying this abnormality, and surgical correction results in improved post-operative hearing outcomes, potentially obviating the need for hearing amplification.
Topics: Adolescent; Child; Child, Preschool; Female; Hearing; Hearing Loss, Conductive; Hearing Tests; Humans; Male; Malleus; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Tympanoplasty
PubMed: 31136915
DOI: 10.1016/j.ijporl.2019.05.021 -
Otology & Neurotology : Official... May 2003
Topics: Fractures, Bone; Hearing Loss, Conductive; Humans; Malleus; Tomography, X-Ray Computed
PubMed: 12806309
DOI: 10.1097/00129492-200305000-00027 -
The Laryngoscope Jan 2008The malleus-stapes offset create challenges during ossiculoplasty, specifically the positioning of an interposed incus or replacement prosthesis relative to the...
BACKGROUND
The malleus-stapes offset create challenges during ossiculoplasty, specifically the positioning of an interposed incus or replacement prosthesis relative to the manubrium.
OBJECTIVES
To depict the malleus-stapes offset, its relationship to the orientation of the manubrium as viewed through the external ear canal relative to a horizontal plane, and mastoid pneumatization size.
STUDY DESIGN
Postmortem anatomic dissection of 41 bequeathed adult crania (82 temporal bones) without clinical otitis.
METHODS
The malleus-stapes offset was analyzed both as a surgeon does intraoperatively and from above through the tegmen tympani. Mastoid sizes were determined radiographically.
RESULTS
: From the surgeon's perspective, for the right ear, the "height" (manubrium to caput stapedis) ranged from 0 to 1.5 (mean, 0.5) mm; the "horizontal" offset ranged from 1.0 to 4.0 (mean, 2.2) mm. Differences in angular offset, as viewed transcanally versus trans-tegmenally, averaged 8.5 degrees (range to 53 degrees). Both height and horizontal offset exhibited wide intersubject variability, quite weak bilateral symmetry, and no relationship with either manubrium orientation or mastoid size.
CONCLUSION
Reliable determination of the malleus-stapes offset is difficult. Because the error of visual offset assessment exceeds the generally accepted 45 degrees alignment allowance for an ossicular prosthesis, visualized ossiculoplasty alignment should be perfect. The ranges of manubrium-stapes offset do not correlate with either manubrium orientation or the extent of mastoid pneumatization.
Topics: Adult; Body Weights and Measures; Cadaver; Ear Canal; Humans; Malleus; Mastoid; Stapes; Temporal Bone
PubMed: 17989583
DOI: 10.1097/MLG.0b013e318155a299 -
Cureus Jun 2019Isolated malleus fractures are an infrequent cause of hearing loss. Even more unusual is a fracture secondary to a sneeze. Here, we review the case of a 32-year-old man...
Isolated malleus fractures are an infrequent cause of hearing loss. Even more unusual is a fracture secondary to a sneeze. Here, we review the case of a 32-year-old man with the first surgically confirmed malleus fracture due to a suppressed sneeze, which was then successfully repaired with hydroxyapatite bone cement. We discuss the presentation, diagnosis, and management of this patient and review the literature on isolated malleus injuries.
PubMed: 31501729
DOI: 10.7759/cureus.5037 -
The Annals of Otology, Rhinology, and... May 2010We present a familial association of radiographically and surgically demonstrated mallear fixation with concurrent stapedial abnormality and dehiscence of the facial... (Review)
Review
We present a familial association of radiographically and surgically demonstrated mallear fixation with concurrent stapedial abnormality and dehiscence of the facial nerve in a father and son, including history, physical findings, surgical findings, radiologic analyses, and a literature review. A 12-year-old boy presented with long-term left-sided conductive hearing loss, and was found to have mallear fixation and a dehiscent facial nerve on a computed tomographic (CT) scan of the temporal bone. Release of the malleus was performed at surgery, revealing hypermobility of the remaining ossicular chain. A repeat CT scan of the temporal bone showed successful release of the mallear head. The patient's father later presented with bilateral hearing loss, and a CT scan of the temporal bones showed bilateral osseous fixation of the mallear head to the tegmen and bilateral facial nerve dehiscences. He underwent right middle ear exploration, but release of the malleus was not performed because of the risk to the dehiscent facial nerve. The stapes crurae were found to be filiform at surgery. This is the first reported familial association of mallear fixation. Mallear fixation with facial nerve dehiscence and an abnormal stapes occurring in a parent and his child is interesting embryologically, and suggests that these anomalies may be genetically linked.
Topics: Child; Congenital Abnormalities; Facial Nerve; Hearing Loss, Conductive; Humans; Male; Malleus; Stapes; Temporal Bone; Tomography, X-Ray Computed
PubMed: 20524577
DOI: 10.1177/000348941011900508 -
European Annals of Otorhinolaryngology,... Jan 2022The main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The... (Observational Study)
Observational Study
OBJECTIVES
The main goal of the present study was to assess hearing outcome for malleus removal in cholesteatoma surgery compared to a group with malleus conservation. The secondary aim was to compare the auditory involvement of the stapes between the two groups.
MATERIAL AND METHODS
A single-center observational study included adult patients operated on by ossiculoplasty for acquired cholesteatoma between 2015 and 2019. Endpoints comprised improvement in pure-tone average air-bone gap (PTA-ABG) and air-bone gap (ABG) at conversational frequencies and, independently, per frequency. 136 patients were included: 95 with conserved malleus (M+) and 41 with malleus removal (M(). Mean time to audiometric follow-up was 9 months in both groups.
RESULTS
The PTA-ABG improvement was 4.4±12.6dB for the M+ group and 3.8±13.4dB for the M- group, with no significant significance (P=0.8). Better results (not exceeding 7.5dB) were found for the M+ group at 2 and 8kHz (P=0.3 and P=0.052 respectively). Presence or absence of the stapes did not affect the results in either group.
CONCLUSION
Those results suggest a negligible role of the malleus in early hearing outcome of tympanoplasty for cholesteatoma. A slight improvement was observed in the M+ group at 2 and 8kHz, but its interpretation remains uncertain.
Topics: Adult; Audiometry, Pure-Tone; Cholesteatoma, Middle Ear; Cohort Studies; Hearing; Humans; Malleus; Ossicular Prosthesis; Ossicular Replacement; Retrospective Studies; Treatment Outcome; Tympanoplasty
PubMed: 34052161
DOI: 10.1016/j.anorl.2021.05.002 -
The Annals of Otology, Rhinology, and... Jan 2013Wide ranges of dimensions of the malleus and incus have been reported for various human populations. Unaddressed are concordance of malleus and incus sizes, bilateral... (Comparative Study)
Comparative Study
OBJECTIVES
Wide ranges of dimensions of the malleus and incus have been reported for various human populations. Unaddressed are concordance of malleus and incus sizes, bilateral symmetry, whether ossicle size correlates with otitis media, and whether second-branchial arch derivatives have more variability than first-arch derivatives. We sought to quantitatively describe the malleus and incus in a population not heretofore reported, with the following hypotheses in mind: 1) an ear's malleus and incus sizes are concordant; 2) a cranium's malleus and incus sizes have bilateral symmetry; 3) the sizes of the malleus and incus are unrelated to the mastoid-size indicator of childhood otitis media; and 4) second-branchial arch derivatives have more variability than do first-arch derivatives.
METHODS
We performed a postmortem material analysis of 41 adult crania without clinical otitis.
RESULTS
The sizes of clinically normal mallei (eg, 21.2 to 30.7 mg) and incudes (eg, 24.4 to 37.4 mg) were varied. Concordance of malleus mass and incus mass was found. However, no relation of malleus and incus sizes with mastoid size was found. The variability of first-arch derivatives was similar to that of second-arch derivatives.
CONCLUSIONS
Clinically normal mallei and incudes had masses and dimensions that varied even more than previously reported. Nevertheless, bilateral symmetry was exhibited, as was concordance of masses.
Topics: Adult; Cadaver; Humans; Incus; Malleus; Organ Size; Temporal Bone
PubMed: 23472318
DOI: 10.1177/000348941312200111