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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 -
Nature Communications Oct 2023The middle ear ossicles in modern mammals are repurposed from postdentary bones in non-mammalian cynodonts. Recent discoveries by palaeontological and embryonic studies...
The middle ear ossicles in modern mammals are repurposed from postdentary bones in non-mammalian cynodonts. Recent discoveries by palaeontological and embryonic studies have developed different models for the middle ear evolution in mammaliaforms. However, little is known about the evolutionary scenario of the middle ear in early therians. Here we report a detached middle ear preserved in a new eutherian mammal from the Early Cretaceous Jehol Biota. The well-preserved articulation of the malleus and incus suggest that the saddle-shaped incudomallear joint is a major apomorphy of Early Cretaceous eutherians. By contrast to the distinct saddle-like incudomallear articulation in therians, differences between the overlapping versus the half-overlapping incudomallear joints in monotremes and stem mammals would be relatively minor. The middle ear belongs to the microtype by definition, indicating its adaptation to high-frequency hearing. Current evidence indicates that significant evolutionary innovations of the middle ear in modern therians evolved in Early Cretaceous.
Topics: Animals; Biological Evolution; Phylogeny; Eutheria; Mammals; Ear, Middle; Fossils
PubMed: 37884521
DOI: 10.1038/s41467-023-42606-7 -
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 -
The Laryngoscope May 2024To report the case of the simultaneous treatment of otosclerosis and malleus fixation through an entirely endoscopic transcanal approach. A targeted transcanalar...
To report the case of the simultaneous treatment of otosclerosis and malleus fixation through an entirely endoscopic transcanal approach. A targeted transcanalar epitympanotomy with annular bony ridge conservation was planned preoperatively, with 3D CT localization of the fixed part of the malleus head. The upper part of the malleus head and the superior ossified ligament of the malleus were drilled. A 0.6 mm stapedotomy was performed and a piston inserted. The patient's recovery was uneventful, with closure of the air-bone gap on her postoperative audiogram, associated with an overclosure in 500Hz, 1kHz, 2 kHz and 4 kHz. Laryngoscope, 134:2411-2414, 2024.
Topics: Humans; Female; Otosclerosis; Malleus; Bone Conduction; Stapes Surgery; Endoscopy; Treatment Outcome; Retrospective Studies
PubMed: 37792383
DOI: 10.1002/lary.31093 -
Journal of the Association For Research... Oct 2023Sheep are used as a large-animal model for otology research and can be used to study implantable hearing devices. However, a method for temporal bone extraction in...
PURPOSE
Sheep are used as a large-animal model for otology research and can be used to study implantable hearing devices. However, a method for temporal bone extraction in sheep, which enables various experiments, has not been described, and literature on middle ear access is limited. We describe a method for temporal bone extraction and an extended facial recess surgical approach to the middle ear in sheep.
METHODS
Ten temporal bones from five Hampshire sheep head cadavers were extracted using an oscillating saw. After craniotomy and removal of the brain, a coronal cut was made at the posterior aspect of the orbit followed by a midsagittal cut of the occipital bone and disarticulation of the atlanto-occipital joint. Temporal bones were surgically prepared with an extended facial recess approach. Micro-CT scans of each temporal bone were obtained, and anatomic dimensions were measured.
RESULTS
Temporal bone extraction was successful in 10/10 temporal bones. Extended facial recess approach exposed the malleus, incus, stapes, and round window while preserving the facial nerve, with the following surgical considerations: minimally pneumatized mastoid; tegmen (superior limit of mastoid cavity) is low-lying and sits below temporal artery; chorda tympani sacrificed to optimize middle ear exposure; incus buttress does not obscure view of middle ear. Distance between the superior aspect of external auditory canal and tegmen was 2.7 (SD 0.9) mm.
CONCLUSION
We identified anatomic landmarks for temporal bone extraction and describe an extended facial recess approach in sheep that exposes the ossicles and round window. This approach is feasible for studying implantable hearing devices.
Topics: Sheep; Animals; Temporal Bone; Ear, Middle; Mastoid; Round Window, Ear; Otolaryngology
PubMed: 37684421
DOI: 10.1007/s10162-023-00907-0 -
Singapore Medical Journal Aug 2023A retrospective study (2011 to 2018) was conducted to evaluate the management of cholesteatomas with labyrinthine fistulae (LFs), clinical characteristics and...
INTRODUCTION
A retrospective study (2011 to 2018) was conducted to evaluate the management of cholesteatomas with labyrinthine fistulae (LFs), clinical characteristics and postoperative hearing outcomes in a hospital.
METHODS
Demographic data of patients with primary middle ear mastoidectomies for cholesteatoma were extracted. Preoperative high-resolution computed tomography (HRCT) temporal bone and intraoperative findings, and hearing levels preoperatively and postoperatively were evaluated.
RESULTS
Of the middle ear cholesteatomas, 15.6% (n = 14) of ears were complicated by LF. HRCT scans showed 92.9% sensitivity and 94.7% specificity in the identification of LFs. Intraoperative findings of LFs include stapes erosion (78.6%), malleus erosion (78.6%), incus erosion (92.9%), dehiscence of tegmen tympani (28.6%) and tympanic facial canal (64.3%). Compared to the non-LF group, the LF group showed significantly higher incidence of stapes erosion (P < 0.001), tegmen tympani dehiscence (P = 0.016) and semicircular canal dehiscence (P < 0.001). Matrix was removed completely in 85.7% (n = 12) and was left behind in 14.3% (n = 2) of ears. Also, 21.5% (n = 3) had preoperative dead ears. Postoperative hearing results had a mean follow-up time of 2.1 (standard deviation 1.5, range 0.14-4.84) years. In the matrix removal group (n = 9), 77.9% had unchanged hearing levels, 11.1% showed improvement and 11.1% showed decrease in hearing levels. The matrix preservation group (n = 2) had deteriorated hearing levels.
CONCLUSION
Preservation of hearing in LFs is possible with cautious matrix removal. Despite matrix preservation to preserve hearing in large LFs, our patients' hearing deteriorated postoperatively. Longer follow-up of hearing with matrix preservation may show poorer hearing outcomes.
PubMed: 37675676
DOI: 10.4103/singaporemedj.SMJ-2021-377 -
Cureus Aug 2023Chronic otitis media refers to middle ear inflammation. A radiological exam is a crucial step in this diagnostic process, in addition to a clinical evaluation and an...
INTRODUCTION
Chronic otitis media refers to middle ear inflammation. A radiological exam is a crucial step in this diagnostic process, in addition to a clinical evaluation and an evaluation by an audiologist. For the development of innovative surgical treatment plans for middle ear otitis media with the aim of minimally invasive surgery, accurate information regarding the extent of lesions is required. This is made possible by a temporal bone imaging test.
MATERIALS AND METHODS
The study was conducted at the Rajendra Institute of Medical Sciences (RIMS), a tertiary care facility in Ranchi, Jharkhand, India. The research was conducted between June 1, 2021, and October 31, 2022. In this prospective observational study, 50 patients who visited the otorhinolaryngology clinic at RIMS Ranchi were the participants.
RESULTS
The median age was 26 years, there was a male-to-female ratio of 1.63 to 1, and the vast majority (84%) were from lower socioeconomic classes. High-resolution computed tomography has been shown to be highly sensitive and specific in identifying conditions including scutum erosion, malleus erosion, pneumatization type, mastoiditis, mastoid abscess, and morphological abnormalities such as low-lying dura.
CONCLUSION
The semicircular canal, fallopian canal, dural plate, and sigmoid sinus may all be clearly defined by non-contrast computed tomography of the temporal bone in erosion in cases of otitis media.
PubMed: 37664290
DOI: 10.7759/cureus.42813 -
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 -
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