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American Journal of Otolaryngology 2024Isolated malleus fractures are a rare occurrence with few reported cases in the literature. Symptoms include sudden otalgia, hearing loss, tinnitus and aural fullness....
Isolated malleus fractures are a rare occurrence with few reported cases in the literature. Symptoms include sudden otalgia, hearing loss, tinnitus and aural fullness. Work-up and diagnosis are based on a combination of thorough anamnesis and careful otoscopic evaluation or high-resolution computer tomography. We present two cases of isolated malleus handle fractures who were diagnosed based on a combination of pneumatic otoscopy and tympanometry. Both fractures were surgically repaired using hydroxyapatite bone cement as showcased in the supplemental video material. Post-operative audiometry showed improvement in the pure-tone-average of both patients as well as normalisation of tympanometry. Isolated malleus fracture should be suspected in cases of sudden hearing loss and tinnitus following digital manipulation of the outer ear canal together with a conductive hearing loss with a mostly high-frequent air-bone-gap and hypercompliant tympanometry with hypermobility of the tympanic membrane on pneumatic insufflation. Surgical repair of the fracture using bone cement has good hearing outcomes and leads to improvement in auditory symptoms.
Topics: Humans; Bone Cements; Malleus; Male; Fractures, Bone; Female; Adult; Hearing Loss, Conductive; Otoscopy; Acoustic Impedance Tests; Tomography, X-Ray Computed; Middle Aged; Audiometry, Pure-Tone; Hydroxyapatites
PubMed: 38492552
DOI: 10.1016/j.amjoto.2024.104256 -
Ear, Nose, & Throat Journal Feb 2024We examined the relationship between factors of middle ear conditions and the outcome of ossiculoplasty in chronic otitis media (COM) by measuring the improvement in...
We examined the relationship between factors of middle ear conditions and the outcome of ossiculoplasty in chronic otitis media (COM) by measuring the improvement in the air-bone gap (ABG) and air conduction threshold (TAC). This retrospective study analyzed 76 patients (77 ears) who underwent ossiculoplasty from among 520 COM patients who underwent tympanoplasty based on the maximum preservation of the original ossicles. The reconstructed ossicular chain was performed by preserving or utilizing the remaining malleus in all cases with the presence of the malleus manubrium. Patients with eardrum adhesion, cholesteatoma, and cholesterol granuloma were defined as having a compromised middle ear condition (Group A), and those without as having an uncompromised middle ear condition (Group B). In each group, pure-tone audiometry was performed preoperatively and postoperatively, and improvements in the ABG and TAC were compared. The effects of the types of tympanoplasty and the method of ossiculoplasty (columella versus incus interposition) on postoperative ABG and TAC were also compared. The postoperative ABG improvement in Group B was significantly higher than that in Group A [β = 7.31, 95% confidence interval (CI) = 1.93-12.69, < .05]. Type III minor columella tympanoplasty yielded significantly better results than type III major and type Vb tympanoplasty (β = 11.42, 95% CI = 5.16-17.68, < .01). There were no significant differences in the postoperative ABG or TAC between the reconstruction groups with and without preservation of malleus. Our results indicate that complex cases compromised by adhesions, cholesteatoma, and cholesterol granuloma have worse outcomes regarding hearing improvement and success rates, while those with intact stapes suprastructure have better outcomes. Malleus was maximally preserved in the patients of this study; however, this showed no significant prognostic benefit in hearing.
PubMed: 38411122
DOI: 10.1177/01455613241230843 -
Scientific Data Feb 2024Endoscopic optical coherence tomography (OCT) offers a non-invasive approach to perform the morphological and functional assessment of the middle ear in vivo. However,...
Endoscopic optical coherence tomography (OCT) offers a non-invasive approach to perform the morphological and functional assessment of the middle ear in vivo. However, interpreting such OCT images is challenging and time-consuming due to the shadowing of preceding structures. Deep neural networks have emerged as a promising tool to enhance this process in multiple aspects, including segmentation, classification, and registration. Nevertheless, the scarcity of annotated datasets of OCT middle ear images poses a significant hurdle to the performance of neural networks. We introduce the Dresden in vivo OCT Dataset of the Middle Ear (DIOME) featuring 43 OCT volumes from both healthy and pathological middle ears of 29 subjects. DIOME provides semantic segmentations of five crucial anatomical structures (tympanic membrane, malleus, incus, stapes and promontory), and sparse landmarks delineating the salient features of the structures. The availability of these data facilitates the training and evaluation of algorithms regarding various analysis tasks with middle ear OCT images, e.g. diagnostics.
Topics: Humans; Algorithms; Ear, Middle; Neural Networks, Computer; Tomography, Optical Coherence
PubMed: 38409278
DOI: 10.1038/s41597-024-03000-0 -
Biology Feb 2024Nowadays, the infraorder Delphinida (oceanic dolphins and kin) represents the most diverse extant clade of Cetacea, with delphinids alone accounting for more than 40% of...
Nowadays, the infraorder Delphinida (oceanic dolphins and kin) represents the most diverse extant clade of Cetacea, with delphinids alone accounting for more than 40% of the total number of living cetacean species. As for other cetacean groups, the Early Miocene represents a key interval for the evolutionary history of Delphinida, as it was during this time span that the delphinidans became broadly distributed worldwide, first and foremost with the widespread genus and closely related forms. Here, we report on a new odontocete find from Burdigalian (20.4-19.0 Ma) deposits of the Friulian-Venetian Basin of northeastern Italy, consisting of the partial cranium of a small delphinidan with associated ear bones (right periotic, stapes, malleus and tympanic bulla). Osteoanatomical considerations and comparisons allow us to assign the studied specimen to the genus . This is the first confirmed record of from Europe as well as from the whole proto-Mediterranean region. Stratigraphic and phylogenetic considerations suggest that our new specimen may represent the geologically oldest member of . The evolutionary success of may correlate with the emergence of narrow-band high-frequency echolocation as a possible strategy to escape acoustic detection by large marine predators such as the squalodontids. In addition, the relatively high encephalization quotient of spp. may have provided these early dolphins with some kind of competitive advantage over the coeval non-delphinidan odontocetes.
PubMed: 38392334
DOI: 10.3390/biology13020114 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2024To investigate the surgical outcomes and safety of the follower arm endoscope holder in assisting type Ⅰ tympanoplasty. The clinical data of 16 patients who underwent...
To investigate the surgical outcomes and safety of the follower arm endoscope holder in assisting type Ⅰ tympanoplasty. The clinical data of 16 patients who underwent type Ⅰ tympanoplasty at the Department of Otorhinolaryngology, Peking Union Medical College Hospital, from November 2022 to September 2023 were retrospectively analyzed, among which 8 cases were operated by traditional otoscopy and 8 cases were operated by supported endoscopy.The surgical procedure was analyzed and the completion of supported endoscopic operation was observed, while the duration of the operation, the time consumed by the main steps, the frequency of wiping the lenses, the perioperative complications, and the improvement of the postoperative hearing were recorded and statistically analyzed. Supporting endoscopic technology achieved real-time suction of bleeding, simultaneous traction and separation of tissues, precise removal of calcified spots on the inner side of the eardrum, trimming of the external auditory canal flap, stable separation of the handle of the malleus and the eardrum, and tensioned repositioning of the skin-cartilage flap. The average duration of surgery, time for external auditory canal flap preparation, and time for repositioning the skin-cartilage flap were reduced in the supporting endoscopic surgery group compared to the control group. The average lens wiping frequency was significantly lower in the supporting endoscopic surgery group compared to the control group. There was no statistically significant difference in postoperative hearing improvement between the two groups, and no infections or the need for secondary surgery due to eardrum re-perforation occurred postoperatively. Supported endoscopy technology realizes the need for endoscopic two-handed operation and convenient switching between one and two hands, accomplishes many operations that cannot be done by traditional endoscopic surgery, solves the problems of previous intraoperative one-handed operation and image instability, shortens the average operation time compared with traditional otoscopic surgery, and decreases the frequency of intraoperative wiping of the lens significantly compared with traditional otoscopic surgery, which is potentially worthwhile in terms of shortening the learning curve.
Topics: Humans; Tympanoplasty; Retrospective Studies; Arm; Myringoplasty; Endoscopes; Endoscopy; Tympanic Membrane Perforation; Treatment Outcome
PubMed: 38297863
DOI: 10.13201/j.issn.2096-7993.2024.02.006 -
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 -
Laryngoscope Investigative... Dec 2023We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with...
OBJECTIVE
We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle.
MATERIALS AND METHODS
Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed.
RESULTS
Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively ( < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group ( = .029 and = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies ( = .011 and = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies.
CONCLUSION
Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.
PubMed: 38130269
DOI: 10.1002/lio2.1175 -
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