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Ear, Nose, & Throat Journal Oct 2022Osteoma is common in the temporal bone but extremely rare in the middle ear cavity and incus. Computed tomography plays an important role in the diagnosis of this slow...
Osteoma is common in the temporal bone but extremely rare in the middle ear cavity and incus. Computed tomography plays an important role in the diagnosis of this slow growing benign osseous mass. The treatment of this lesion, which usually causes conductive type hearing loss, includes follow-up and surgery according to the patient's condition.
PubMed: 36219206
DOI: 10.1177/01455613221130887 -
Otology & Neurotology : Official... Feb 2011Use of the SMart piston, a nitinol-based, self-crimping prosthesis in stapes surgery may allow improved functional results because of better sound transmission...
OBJECTIVE
Use of the SMart piston, a nitinol-based, self-crimping prosthesis in stapes surgery may allow improved functional results because of better sound transmission properties at the incus-prosthesis interface because of the elimination of manual crimping. Possible disadvantages include thermal damage or strangulation of the incus and its mucoperiosteum or nickel intolerance. The goal of this study was to morphologically assess the fixation of this prosthesis to the incus, investigate the reaction of the middle ear mucosa to the prosthesis, identify alterations to the incudal bone, and detect deposits of nickel in the tissue around the prosthesis.
STUDY DESIGN
Prospective consecutive case analysis.
SETTING
Tertiary referral center.
PATIENTS
Four patients with an unfavorable functional result after primary SMart-piston stapedotomy.
INTERVENTION
Revision malleostapedotomy with explantation of the incus and prosthesis for further analysis.
MAIN OUTCOME MEASURES
Analysis of intraoperative findings and postoperative examination of the explants using light- and scanning-electron microscopy, energy dispersive x-ray analysis, and atom absorption spectrometry.
RESULTS
The intraoperative, macroscopic, and scanning electron microscopic investigation showed tight circular fixation of the prostheses, whereas a gap between the prosthesis and the lateral incus was found in 1 case. All prostheses were overgrown by mucosa. Superficial localized erosion of the incudal bone was found in 2 cases. There was no elevation in nickel content in the removed tissue samples.
CONCLUSION
The lateral gap between prosthesis and incus did not affect fixation of the prosthesis, neither did covering by a mucosal layer. Bone erosion was most likely caused by laser in one and by the prosthesis in another explant. No signs of increased nickel deposits could be found on energy dispersive x-ray analysis or atom absorption spectrometry. We conclude that a nitinol stapes prosthesis is safe for treatment of stapedial fixation.
Topics: Adult; Alloys; Biocompatible Materials; Cochlear Implantation; Ear Canal; Ear, Middle; Female; Humans; Incus; Male; Materials Testing; Microscopy, Electron, Scanning; Middle Aged; Mucous Membrane; Nickel; Ossicular Prosthesis; Spectrophotometry, Atomic; Stapes Surgery
PubMed: 21150688
DOI: 10.1097/MAO.0b013e318201622e -
Journal of Otology Jun 2019To investigate immune-related genetic background in intractable Meniere's disease (MD) and the immediate results of a novel therapy by delivering steroids to the surface...
Autoinflammatory characteristics and short-term effects of delivering high-dose steroids to the surface of the intact endolymphatic sac and incus in refractory Ménière's disease.
OBJECTIVE
To investigate immune-related genetic background in intractable Meniere's disease (MD) and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac (ES) and incus in a sustainable manner.
CASE REPORT AND METHODS
Candidate genes involved in immune regulation were sequenced using a next-generation sequencing method in a patient with intractable MD. Mutations were confirmed using the Sanger sequencing method. The ES was exposed, and gelatin sponge particles were immersed in high-dose methylprednisolone solution and placed onto the surface of ES. "L"-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES. Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.
RESULTS
Autoinflammation in the refractory MD case was indicated by genotype, including novel heterozygous mutations of PRF1, UNC13D, SLC29A3, ITCH, and JAK3, as well as phenotype. The vertigo was fully relieved immediately after operation. Tinnitus and aural fullness were resolved 3 weeks after operation, whereas hearing improved in 2 mon postoperation. No recurrence was noted during the 5-monfollow-up, and the final MRI supported the novel therapeutic hypothesis.
CONCLUSION
Autoinflammation was involved in a refractory MD. This novel therapy, which involves the delivery of steroids to the surface of the intact ES and incus, is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.
PubMed: 31223300
DOI: 10.1016/j.joto.2019.01.001 -
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 -
Journal of Anatomy Jul 2021Animal body parts evolve with variable degrees of integration that nonetheless yield functional adult phenotypes: but, how? The analysis of modularity with Anatomical... (Comparative Study)
Comparative Study
Animal body parts evolve with variable degrees of integration that nonetheless yield functional adult phenotypes: but, how? The analysis of modularity with Anatomical Network Analysis (AnNA) is used to quantitatively determine phenotypic modules based on the physical connection among anatomical elements, an approach that is valuable to understand developmental and evolutionary constraints. We created anatomical network models of the head, forelimb, and hindlimb of two taxa considered to represent a 'generalized' eutherian (placental: mouse) and metatherian (marsupial: opossum) anatomical configuration and compared them with our species, which has a derived eutherian configuration. In these models, nodes represent anatomical units and links represent their physical connection. Here, we aimed to identify: (1) the commonalities and differences in modularity between species, (2) whether modules present a potential phylogenetic character, and (3) whether modules preferentially reflect either developmental or functional aspects of anatomy, or a mix of both. We predicted differences between networks of metatherian and eutherian mammals that would best be explained by functional constraints, versus by constraints of development and/or phylogeny. The topology of contacts between bones, muscles, and bones + muscles showed that, among all three species, skeletal networks were more similar than musculoskeletal networks. There was no clear indication that humans and mice are more alike when compared to the opossum overall, even though their musculoskeletal and skeletal networks of fore- and hindlimbs are slightly more similar. Differences were greatest among musculoskeletal networks of heads and next of forelimbs, which showed more variation than hindlimbs, supporting previous anatomical studies indicating that in general the configuration of the hindlimbs changes less across evolutionary history. Most observations regarding the anatomical networks seem to be best explained by function, but an exception is the adult opossum ear ossicles. These ear bones might form an independent module because the incus and malleus are involved in forming a functional primary jaw that enables the neonate to attach to the teat, where this newborn will complete its development. Additionally, the human data show a specialized digit 1 module (thumb/big toe) in both limb types, likely the result of functional and evolutionary pressures, as our ape ancestors had highly movable big toes and thumbs.
Topics: Animals; Forelimb; Head; Hindlimb; Humans; Mice; Models, Theoretical; Opossums; Phylogeny; Skeleton
PubMed: 33629373
DOI: 10.1111/joa.13409 -
Hearing Research Jan 2023The time delay and/or malfunctioning of the Eustachian tube may cause pressure differences across the tympanic membrane, resulting in quasi-static movements of the... (Review)
Review
The time delay and/or malfunctioning of the Eustachian tube may cause pressure differences across the tympanic membrane, resulting in quasi-static movements of the middle-ear ossicles. While quasi-static displacements of the human middle-ear ossicles have been measured one- or two-dimensionally in previous studies, this study presents an approach to trace three-dimensional movements of the human middle-ear ossicles under static pressure loads in the ear canal (EC). The three-dimensional quasi-static movements of the middle-ear ossicles were measured using a custom-made stereo camera system. Two cameras were assembled with a relative angle of 7° and then mounted onto a robot arm. Red fluorescent beads of a 106-125 µm diameter were placed on the middle-ear ossicles, and quasi-static position changes of the fluorescent beads under static pressure loads were traced by the stereo camera system. All the position changes of the ossicles were registered to the anatomical intrinsic frame based on the stapes footplate, which was obtained from µ-CT imaging. Under negative ear-canal pressures, a rotational movement around the anterior-posterior axis was dominant for the malleus-incus complex, with small relative movements between the two ossicles. The stapes showed translation toward the lateral direction and rotation around the long axis of the stapes footplate. Under positive EC pressures, relative motion between the malleus and the incus at the IMJ became larger, reducing movements of the incus and stapes considerably and thus performing a protection function for the inner-ear structures. Three-dimensional tracing of the middle-ear ossicular chain provides a better understanding of the protection function of the human middle ear under static pressured loads as immediate responses without time delay.
Topics: Humans; Ear, Middle; Ear Ossicles; Incus; Stapes; Rotation
PubMed: 36462376
DOI: 10.1016/j.heares.2022.108651 -
Journal of Anatomy Aug 2022The vascular supply of the human auditory ossicles has long been of anatomical and clinical interest. While the external blood supply has been well-described, there is...
The vascular supply of the human auditory ossicles has long been of anatomical and clinical interest. While the external blood supply has been well-described, there is only limited information available regarding the internal vascular architecture of the ossicles, and there has been little comparison of this between individuals. Based on high-resolution micro-CT scans, we made reconstructions of the internal vascular channels and cavities in 12 sets of ossicles from elderly donors. Despite considerable individual variation, a common basic pattern was identified. The presence of channels within the stapes footplate was confirmed. The long process of the incus and neck of the stapes showed signs of bony erosion in all specimens examined. More severe erosion was associated with interruption of some or all of the main internal vascular channels which normally pass down the incudal long process; internal excavation of the proximal process could interrupt vascular channels in ossicles which did not appear to be badly damaged from exterior inspection. An awareness of this possibility may be helpful for surgical procedures that compromise the mucosal blood supply. We also calculated ossicular densities, finding that the malleus tends to be denser than the incus. This is mainly due to a lower proportion of vascular channels and cavities within the malleus.
Topics: Aged; Ear Ossicles; Ear, Middle; Humans; Incus; Malleus; Tomography, X-Ray Computed
PubMed: 35357009
DOI: 10.1111/joa.13661 -
Hearing Research Mar 2021As an alternative to fresh temporal bones, Thiel conserved specimens can be used in the study of ear mechanics. Conserved temporal bones do not decay, permit long-term...
BACKGROUND AND AIMS
As an alternative to fresh temporal bones, Thiel conserved specimens can be used in the study of ear mechanics. Conserved temporal bones do not decay, permit long-term experiments and overcome problems with limited access to fresh (frozen) temporal bones. Air conduction motion of the tympanic membrane (TM), stapes (ST) and round window (RW) in Thiel specimens is similar to that of fresh specimens according to reports in the literature. Our study compares this motion directly before and after conservation for the same specimens.
METHODS
The magnitude of motion of TM, ST and RW elicited by acoustic stimulation via the external auditory canal was measured using single point laser Doppler vibrometry (LDV) accessed through a posterior tympanotomy. For the initial measurements (10 ears), fresh frozen whole heads were thawed for at least 24 h. Afterwards, the entire whole heads were embalmed according to the Thiel embalming method and measurements were repeated 3 and 12 months later.
RESULTS
The magnitudes of TM, ST and RW motion before and after Thiel conservation differed maximally 10 dB on average. A significant increase in TM motion was observed at low frequencies only after long term conservation (12 months). ST motions decreased significantly between 161 and 5300 Hz after 3 months of Thiel conservation. Over the same time period RW motions decreased significantly between 100 and 161 Hz and 489-788 Hz. The ST and RW motions across all measured frequencies were lower after 3 months by 5.7 dB and 7.1 dB, respectively, without further changes after 12 months of conservation. The mean phase shift between ST and RW motion was only 2.1° for frequencies below 450 Hz.
DISCUSSION AND CONCLUSION
Thiel embalming changes motion of TM after long term conservation. ST and RW motion changed mainly after short term conservation. The phase shifts close to 180° between ST and RW motion indicates that the cochlea was still filled with liquid without air bubbles. The results show that Thiel conserved specimens can be used as an alternative model to fresh frozen preparations with some limitations when studying mechanics of the normal human ear, for example, in implant design.
Topics: Acoustic Stimulation; Embalming; Humans; Incus; Ossicular Prosthesis; Round Window, Ear; Stapes; Temporal Bone
PubMed: 33388646
DOI: 10.1016/j.heares.2020.108152 -
Frontiers in Neurology 2021To analyze intensity-latency functions of intraoperative auditory evoked brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear...
OBJECTIVE
To analyze intensity-latency functions of intraoperative auditory evoked brainstem responses (ABRs) to stimulation by the Vibrant Soundbridge (VSB) active middle ear implant with respect to coupling efficiency, VSB evoked ABR thresholds, and coupling modality [oval window (OW) placement vs. Incus placement and vs. round window (RW) placement].
STUDY DESIGN
Exploratory study.
SETTING
Bi-centric study at tertiary referral centers.
PATIENTS
Twenty-four patients (10 female, 14 male, mean age: 58 years) who received a VSB.
OUTCOME MEASURES
Wave-V intensity-latency functions of intraoperative VSB evoked ABRs using a modified audio processor programmed to preoperative bone conduction thresholds for stimulation. Threshold level correction to coupling efficiency and ABR thresholds. Individual plots and exponential function fits.
RESULTS
After ABR threshold level correction, the latency functions could be aligned. A large variance of latencies was observed at individual threshold level. Wave-V latency was longest in the Incus placement subgroup (9.73 ms, SD: 1.04) as compared to OW placement subgroup (9.47 ms, SD: 1.05), with the shortest latency in the RW placement subgroup (8.99 ms, SD: 0.68). For increasing stimulation levels, the variance decreased with intensity-latency function slopes converging toward a steady-state (saturation) latency caused by saturation of audio processor (stimulation) gain. Latency saturation was reached at a stimulation level of 50 dB nHL for the OW placement subgroup, 35 dB nHL for the Incus placement subgroup, and 30 dB nHL for the RW placement subgroup. The latency and saturation results indicated decreased dynamic range for RW placement, i.e., reverse stimulation.
CONCLUSIONS
VSB evoked ABR wave-V intensity-latency function slopes were similar to acoustic stimulation at high stimulation levels with a shift toward longer latencies caused by audio processor signal delay. Saturation of latencies occurred for higher stimulation levels due to saturation of audio processor gain. Thus, the analysis of VSB evoked intensity-latency functions appears to allow for the objective assessment of a patient's individual dynamic range. This can further improve diagnostics as well as intraoperative and postoperative quality control.
PubMed: 35126279
DOI: 10.3389/fneur.2021.739906 -
Indian Journal of Otolaryngology and... Mar 2022Chronic otitis media (COM) is a common disease that can cause damage to the middle ear ossicles and thus lead to conductive hearing loss. The purpose of this study was...
Incus Autograft Partial Ossicular Reconstruction Prosthesis vs. Titanium Angular Clip Prosthesis in Patients with Incudostapedial Joint Erosion Caused by Chronic Otitis Media; A Randomized Clinical Trial.
Chronic otitis media (COM) is a common disease that can cause damage to the middle ear ossicles and thus lead to conductive hearing loss. The purpose of this study was to compare two methods of incus partial ossicular reconstruction prosthesis (PORP) and reconstruction with titanium angular clip prosthesis in patients with incudostapedial joint erosion. In this interventional randomized clinical trial carried out in a tertiary referral hospital, patients with chronic otitis media and incudostapedial joint erosion who were candidates for surgery, were randomly allocated into two groups of incus PORP surgery and reconstruction with a titanium angular clip prosthesis. Audiometry was performed for the patients prior to and six months after surgery. Pre- and post-operative air-bone gap (ABG) and bone conduction (BC) thresholds were calculated and means were compared by analysis of variances (ANOVA). A value of <0.05 was considered statistically significant. The study consisted of 24 and 14 subjects in the incus PORP and angular clip groups, respectively. There was no statistically significant difference between the mean pre- and post-operative ABG, BC thresholds and ABG reduction in the compared groups. Considering issues such as high cost and inaccessibility of titanium angular clips in all centers, incus PORP may be a more acceptable method.
PubMed: 35070929
DOI: 10.1007/s12070-021-02605-w