Surgical results of modified canal wall down tympanoplasty

Conclusion: Patients with mastoiditis and chronic suppurative otitis media which has small mastoids that make them ideal candidates for modified canal wall down mastoidectomy (MCWD) which contributes to a dry and spacious ear and the maintaining and improving hearing.

Objectives: To evaluate surgical outcomes for chronic otitis media underwent MCWD.

Methods: A clinical retrospective study was performed on 47 ears with chronic otitis media which has relatively limited attic lesions have the small, sclerotic and hypocellular mastoids according to the preoperative high-resolution CT scan of the temporal bone that underwent MCWD and 32 ears with typical canal wall down operation form January 2010 to January 2016.

Results: In the MCWD group, the mean preoperative air conduction (AC) threshold of 38.2?±?1.1?dB was lowered to 31.0?±?0.8?dB postoperatively (p?p?p?p?相似文献   

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Abstract

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.

Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.

Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.

Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4?±?5.24?dB. The mean ABG was 9.2?±?2.13?dB 1 month postoperatively and 8.5?±?2.26?dB 6 months postoperatively (p?<?.005).

Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn’t require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.     

Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study

Conclusion: The results showed a gradual detachment of otoconia in the utricle after a single event of head vibration, possibly explaining the frequent recurrence of BPPV attacks and persistent dizziness after trauma.

Objectives: This study developed a murine model of traumatic BPPV and observed the changes in otoconia detachment over time.

Methods: Six-week-old CBA mice were used in this study. Otoconia detachment was induced by vibrating the head for 2?min. Utricles of mice were harvested from different groups: before the head vibration and 1?day, 1 week, 1 month, and 3 months after vibration application. Using scanning electron microscopy and ImageJ software, the percentage of the intact area of otoconia in the utricle was calculated. Hearing thresholds were compared among the groups.

Results: The mean (±?SD) percentages of the intact area of otoconia in the utricle were 98.1%?±?1.7% before the vibration and 93.6%?±?1.7%, 88.9%?±?5.3%, 78.2%?±?20.9%, and 38.9%?±?24.1% at 1?day, 1 week, 1 month, and 3 months after the vibration, respectively. The percentage decreased significantly over time after the vibration (p?相似文献   

The efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube patient

Objective: To assess the efficacy of the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) for patulous Eustachian tube (PET) patients.

Methods: A prospective survey of medical records identified 36 patients and 47 ears with PET, and 15 patients and 15 ears as control. The ETDQ-7, patulous Eustachian tube handicap inventory-10 (PHI-10) and Likert scale were evaluated. PET patients were divided into two groups based on severity of symptoms using the PHI score.

Results: The Cronbach α value of the PET group was 0.765. The average total score of the ETDQ-7 in the control group was 7.6?±?1.1 and 22.5?±?10.0 in the PET group (p?r?=?0.248, p?=?.09). The average total score of the ETDQ-7 in the mild or moderate PET group was 19.9?±?9.0 and 25.3?±?11.1 in the severe PET group and this was not statistically different (p?=?.08).

Conclusion: The highest ETDQ-7 score was also observed in PET patients and in ET dysfunction patients. These findings necessitate careful discrimination between ET dysfunction and PET in balloon dilation Eustachian tuboplasty (BET) based on ETDQ-7.     

Finite element analysis of auditory characteristics in patients with middle ear diseases

Conclusion: This study validates that a finite element model of the human ossicular chain and tympanic membrane can be used as an effective surgical assessment tool in clinics.

Objective: The present study was performed to investigate the application of a finite element model of ossicular chain and tympanic membrane for fabrication of individualized artificial ossicles.

Methods: Twenty patients (20 ears) who underwent surgery for middle ear disease (n?=?20) and 10 healthy controls (10 ears) were enrolled in the hospital. Computed tomography (CT) and pure tone audiometry were performed before and after surgery. A finite element model was developed using CT scans, and correlation analysis was conducted between stapes displacement and surgical methods. An audiometric test was also performed for 14 patients before and after surgery.

Results: Stapes displacement in the healthy group (average?=?3.31?×?10^?5?mm) was significantly greater than that in the impaired group (average?=?1.41?×?10^?6 mm) prior to surgery. After surgery, the average displacement in the impaired group was 2.55?×?10^?6 mm, which represented a significant improvement. For the patients who underwent the audiometric test, 10 improved hearing after surgery, and stapes displacement increased in nine of these 10 patients.     

The effect of inlay butterfly cartilage tympanoplasty technique on compliance

Conclusion: IBCT technique should be preferred owing to its high graft survival rate and ABG gain. While no significant difference was found in middle ear pressures between ears that underwent IBCT and normal ears, compliance values were found to be decreased in patients undergoing IBCT. However, the lack of correlation between ABG gain and compliance values indicated that compliance increase had no effect on post-operative ABG results. Objective: The aim of the present study was to compare tympanometric and audiological parameters in patients undergoing inlay butterfly cartilage tympanoplasty (IBCT) with their normal ears and to determine their difference with normal ear tympanometric parameters. Methods: Overall, 25 patients that underwent an operation between August 2010–May 2014 were included in the present study. In 13 of these patients, the ear that did not undergo operation was normal. 0.5, 1, 2, 4?kHz pure sound average values, tympanometric measurements and compliance values of normal and operated ears were compared. Results: The graft survival rate in patients was found to be 92%. Mean pre-operative air–bone gap (ABG) was 16.4?±?5.4 in patients, while mean post-operative ABG was 10.9?±?5.8, with a statistically significant difference (p?=?0.001) While there was no significant difference between operated and normal ears of patients in terms of middle ear pressure (0.441), compliance values were significantly higher in normal ears than those in operated ears (0.032). When post-operative ABG gain was compared with compliance values, no significant correlation was found between ABG gain and compliance measurements (r?=??0.025 and p?=?0.936).     

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.     

Analysis on the correlation between Eustachian tube function and outcomes of type I tympanoplasty for chronic suppurative otitis media

Abstract

Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.

Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).

Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.

Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air–bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p?<?.05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.

Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.     

Results of endoscopic cartilage tympanoplasty procedure with limited tympanomeatal flap incision

Objective: The aim of this study was to evaluate the outcomes of this minimally invasive tympanomeatal incision technique performed during endoscopic transcanal cartilage tympanoplasty.

Study design: Prospective clinical study.

Methods: Eighty-seven patients (87 ears) who had TM perforation with noncomplicated COM were included. All of the patients were operated with the endoscopic transcanal cartilage tympanoplasty technique. All of the data were prospectively collected. These included demographic data, date of the surgery, preoperative and postoperative pure-tone audiometry (PTA), localization of TM perforation and graft healing success.

Results: Mean follow-up time was 14.76?±?4.32 months. Graft-healing rate was 100%. Mean air bone gap level improvement (dB HL) at 0.5, 1, 2 and 4?kHz were 13.87?±?7.30?dB HL, 9.09?±?7.59?dB HL, 9.74?±?6.40?dB HL and 7.46?±?6.37?dB HL, respectively. At all frequencies, there was significant difference between pre and postoperative mean air bone gap levels (p?p?>?.05).

Conclusions: Endoscopic ear surgery has successful surgical outcomes with low complication rates. In this study, the outcomes of limited tympanomeatal flap incision was discussed. It is suggested that this technique is reliable with good hearing results with low postoperative complications rates.     

Nasal and middle ear ciliary beat frequency in chronic suppurative otitis media

The middle ear mucociliary system has been shown to have an important function in the clearance of effusions. Little is known, however, about its role in chronic suppurative otitis media (CSOM). The ciliary beat frequencies of middle ear mucosal biopsies and nasal brushings of 27 patients with CSOM were analysed using a computerized photometric technique. The ciliary beat frequency in the middle ear mucosa was significantly less than that in nasal mucosa. Frequency in ears of smoking patients was significantly lower compared with non-smoking patients. Nasal brushings were taken from 27 otherwise healthy age and sex-matched non-smoking controls and the ciliary beat frequency was very similar to nasal samples from patients with CSOM. Ear controls were obtained from otosclerotic patients undergoing tympanotomy and the beat frequency was significantly higher than in the ear of patients with CSOM. It is concluded that middle ear ciliary function is significantly reduced in CSOM, particularly in patients who smoke.     

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n?=?72) received MeroGel as the MEPA, Group 2 (n?=?64) cartilage, and Group 3 (n?=?69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4?kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9?dB and 17.6?dB in Group 1, 31.4?dB and 21.9?dB in Group 2, and 32.2?dB and 19.1?dB in Group 3. The ABG closure was 13.3?±?7.5 in Group 1, 9.5?±?5.9 in Group 2, and 13.1?±?9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p?p?Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.     

Chorda tympani nerve dysfunction associated with congenital microtia

Conclusion: This is the first report to investigate the correlation between ear anomalies related to the development of specific ear structures and chorda tympani dysfunction (CTD) in congenital microtia. CTD is not always consistent with the severity of the ear anomaly or the presence of facial nerve paralysis (FNP).

Objectives: To investigate the relationship between the severity of ear anomalies and CTD as well as FNP in congenital microtia.

Methods: A retrospective assessment was performed for all patients with microtia over the period 2010–2016. All ears were graded based on the severity of ear deformity using the Jahrsdoerfer system, based on findings on computed tomography of the temporal bone. Electrogustometry (EGM) was performed to evaluate CTD.

Results: The group included 110 male and 62 female patients. The right ear was the most commonly affected (right 106, left 47). Eighteen patients (10.5%) had abnormal EGM thresholds. The mean (±?SD) Jahrsdoerfer scores in the without CTD and positive for CTD groups were 6.53?±?0.32 and 7.06?±?0.37, respectively. In terms of sub-total points, there was no significant correlation between anatomic structure and CTD. There was no significant correlation between CTD and the presence of FNP.     

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect

Purpose

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD).

Dosimetric parameters associated with conductive or sensorineural hearing loss 5 years after intensity-modulated radiation therapy in nasopharyngeal carcinoma

Background: Most previous studies are separate dosimetric analyses of conductive or sensorineural hearing loss, and they are not conducive to a comprehensive assessment of auditory radiation damage.

Aims/objectives: Our study aimed to evaluate the long-term incidence of sensorineural hearing loss (SNHL) or conductive hearing loss (CHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiation therapy (IMRT), and to investigate the relationship between SNHL or CHL and patient factors, treatment-related factors, and radiation dose parameters.

Material and methods: Seventy patients (117 ears) with NPC, who were also treated with IMRT in our hospital from 2006 to 2014, were retrospectively analyzed. Radiation doses to the Eustachian tube (ET), middle ear (ME), cochlear (Co), and internal auditory canal (IAC) were assessed. Pure tone audiometry and impedance audiometry were performed before and during the follow-up period. The relationships between low-frequencies (0.5–2?kHz) or high-frequency (4?kHz) SNHL/CHL and radiotherapy dose parameters were analyzed.

Results: Of the 117 ears studied, 7.69% had low-frequency SNHL, 35.9% had high-frequency SNHL, 23.93% had low-frequency CHL, and 18.80% had high-frequency CHL. The incidence of high-frequency CHL was higher in the T4 group than in the T (1–3) group (p?<?.05). When IAC D_max?>?42.13?Gy or IAC D_mean?>?32.71?Gy, the risk of high-frequency SNHL increased in NPC patients. When ME D_max?>?44.27?Gy, ME D_mean?>?29.28?Gy, or ET D_max?>?57.23?Gy, the risk of high-frequency CHL in NPC patients increased.

Conclusions and significance: SNHL and CHL remain common ear complications after IMRT for NPC. IAC D_max, IAC D_mean, ME D_max, ME D_mean, and ET D_max all need to be carefully considered during the IMRT treatment protocol.     

Intratympanic steroids as a salvage therapy for severe to profound idiopathic sudden sensorineural hearing loss

Abstract

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as a decline in hearing affecting three or more frequencies by 30?dB

Objective: The aim of this study was to evaluate the results of intratympanic steroids as a salvage treatment for severe ISSNHL.

Materials and methods: A regimen of three IT steroid injections was offered to patients who failed a 7-days intravenous steroid treatment. Eighty-four patients underwent IT salvage treatment (IT group). Their outcomes were compared with those of 255 patients with severe ISSNHL who received the same intravenous steroid regimen without salvage IT steroid therapy (Control group).

Results: 56% of the patients in the IT group had a hearing improvement of >15?dB after one month. The average hearing improvements were 26.5?±?28?dB and 27.9?±?24?dB in the IT group and the Control group, respectively (p?=?.67). However, patients with a type E audiogram pattern (total deafness), displayed a substantial hearing gain.

Conclusion: Intratympanic steroids failed to show a global auditory benefit as a salvage treatment in patients with severe ISSNHL.

Significance: Our data suggest that a salvage treatment with intratympanic dexamethasone may be offered to patients with total deafness for whom the first systemic treatment has failed.     

Diagnostic role of cone beam computed tomography for the position of straight array

Objective: To assess the usefulness of cone beam computed tomography (CBCT) for characterizing electrode insertion and evaluate the influence of electrode insertion status on post-cochlear implantation (CI) outcomes.

Design: Twenty-six ears with post-CI CBCT scans were included. The devices were MED-EL Flex28 (n?=?21) and Nucleus slim straight (n?=?5). The parameters including cochlear duct length (CDL), insertion depth angle (IDA), insertion length of electrode (IL), and cochlear coverage (CC) were analyzed and compared with aided pure-tone threshold (PTA) with implant in free field, and open-set sentence score.

Results: The mean CDL was 36.8?±?1.4?mm. Electrode array was dislocated into scala tympani in two ears. The mean IL and IDA were 26.5?±?1.9?mm and 541.4?±?70.2°. The mean linear CC (IL/CDL, 0.73?±?0.06) was larger than the mean angular CC (IDA/900, 0.60?±?0.08). The CBCT parameters showed correlation one another. While the aided pure-tone threshold was correlated with IL and IDA, there were no significant correlations in the open-set sentence score. For the postlingually deaf patients with single electrode (Flex 28), the sentence score had no significant correlation and the aided PTA was positively correlated with IL (R?=?0.517, p?=?.028).

Conclusions: This study validated the CBCT evaluating the electrode array position. The CBCT could be helpful for the preoperative selection of the optimal array and prediction of the CC.     

Repair effect of xenogeneic acellular dermal matrix during external auditory canal reconstruction after canal wall down mastoidectomy

Abstract

Background: In some cases, there is insufficient external auditory canal (EAC) skin to cover the reconstructed canal wall after canal wall down (CWD) mastoidectomy. Acellular dermal matrix (ADM) can help to repair the skin, mucosa and other epidermal tissue defects.

Aims: To investigate the repair effect of xenogeneic ADM (xeno-ADM) for EAC skin defects.

Material and Methods: We retrospectively analyzed 28 patients who underwent open mastoidectomy combined with canal wall reconstruction and mastoid obliteration in our hospital. The xeno-ADM was used to repair the EAC skin defect. The epithelialization time, dressing change times, complications and hearing improvement post-operation were summarized and analyzed.

Results: Reasons for using xeno-ADM included: 11 (39.3%) cases suffered from extensive middle ear cholesteatoma, three (10.7%) cases suffered from advanced EAC cholesteatoma, eight (28.6%) cases to solve the cavity-related problems, and six (21.4%) patients had a narrow EAC. The postoperative epithelialization time was 5.8?±?1.6?weeks, and the number of dressing changes was 4.8?±?1.6 times. There was no xeno-ADM rejection and related complications, the postoperative hearing improvement was statistically significant (p?=?.013).

Conclusions and Significance: Xeno-ADM could be a safe, effective and simple method for repairing skin defect in the reconstruction of EAC after CWD mastoidectomy.     

Round window membrane visibility related to success of hearing preservation in cochlear implantation

Objectives: This study was designed to evaluate the relationship between the degree of round window membrane (RWM) exposure and hearing outcome.

Materials and methods: Forty-six ears with cochlear implantation (CI) were enrolled. The degree of RWM exposure was divided into Grade I (<25%), Grade II (25–50%), and Grade III (>50%). The hearing outcomes were evaluated at 1.5 and 12 months postoperatively.

Results: Twenty-seven ears were Grade I, 13 were Grade II, and 6 were Grade III. RW approach was used in all ears of Grades II and III and 20 ears of Grade I and cochleostomy was used in 7 ears of Grade I. The pattern of bony overhang was multidirectional in 41 ears. Threshold shift significantly decreased proportional to the increase of RWM exposure after CI. The mean RWM exposure was 32.1?±?24.4% in ears with more than partial preservation (n?=?17), and 13.3?±?11.7% in the other ears (n?=?6) at 12 months post-CI (p?=?.061). Age at CI differed significantly between ears that had more than partial preservation and the other ears at 1.5 months post-CI.

Conclusions and significance: Degree of RWM exposure and age at CI might be factors predicting hearing outcome after CI using the RW approach.     

Pharmacokinetics of sodium thiosulfate in Guinea pig perilymph following middle ear application

Hypothesis

To determine the pharmacokinetics of sodium thiosulfate in the inner ear perilymph following middle ear application in Guinea pigs.

Effect of recombinant vascular endothelial growth factor on experimental otitis media with effusion

Conclusion This study demonstrates that rVEGF in the middle ear cavity contributes significantly to the development of OME by increasing the vascular permeability of the middle ear mucosa. Objective Vascular endothelial growth factor (VEGF) has been detected in otitis media with effusion (OME). It has a very strong effect on increasing vascular permeability, and is much more potent than platelet-activating factor, arachidonic acid metabolites or histamine. The purpose of this study was to investigate whether recombinant VEGF (rVEGF) can increase vascular permeability in the middle ear mucosa of rats. Material and methods rVEGF was injected transtympanically at doses of 0.01, 0.1 and 1.0 μg in the experimental groups; normal saline was injected in the control group. Twenty-four h after the injection of rVEGF, middle ear fluid was aspirated and the vascular permeability of the middle ear mucosa was measured by means of the Evans Blue vital dye technique. Results Extravasation of Evans Blue dye was found in all specimens injected with rVEGF, and was quantified using a spectrophotometer. Middle ear fluid developed in all ears injected with 0.1 or 1.0 μg of rVEGF and histopathology of the middle ear mucosa revealed severe inflammatory cellular infiltration, subepithelial edema and vascular dilatation. Rats injected with 1.0 μg of rVEGF showed a significant increase in middle ear vascular permeability in comparison with the control group (p<0.05).