先天性外中耳畸形对儿童患者心理状况的影响

目的：本研究采用Achenbach儿童行为量表对先天性外中耳畸形患儿的心理状况进行测评,了解畸形对患儿心理有无影响及影响程度。方法：66例4~16岁先天性外中耳畸形患儿由家长根据其表现填写行为量表,计算心理行为异常检出率。同时收集一般资料、耳廓Marx分级,对患儿的心理异常检出率进行单因素及多因素分析。结果：外中耳畸形患儿心理异常检出率为21.21%,高于全国常模,差别有统计学意义。耳廓Marx分级及父母压力程度与心理异常检出率相关,多因素Logistic回归分析中Cox＆Snell系数为0.153。其中耳廓Marx分级Ⅲ级的患儿心理异常检出率高达36.4%,高于Ⅱ级畸形患儿。结论：先天性外中耳畸形这一事件对儿童患者心理确有影响,但仅是众多影响因素之一,其对患儿心理造成的影响在所有心理影响因素中的作用约占15%。但耳廓Marx分级Ⅲ级的患者是发生心理异常的高危人群。     

Effect of laser uvulopalatoplasty on middle ear function

OBJECTIVES: Palatal musculature is known to be responsible for the active opening of the eustachian (auditory) tube. Because laser-assisted uvulopalatoplasty (LAUP) may involve partial division of these muscles, the effect of this procedure on middle ear pressures (MEPs) and middle ear volumes (MEVs) was investigated. STUDY DESIGN: A controlled interventional trial with one limb receiving treatment and the other none. Preoperative and postoperative measurements were carried out in both groups. METHODS: A control group of 15 normal volunteers and a study group of 22 patients undergoing LAUP all of whom had normal ears and type A tympanograms before the trial were recruited. Repeat tympanometry was carried out after 3 months in both groups. The results of MEP and MEV were recorded for both groups and analyzed by the Mann-Whitney U test. RESULTS: A trend toward reduced MEP and MEV was noted in the LAUP group, but did not achieve statistical significance. A study with more patients may achieve significance. CONCLUSIONS: No significant effects on middle ear pressures or volumes 3 months after LAUP were demonstrated. A much larger study may, however, arrive at a statistically significant result and further work is warranted. Relevant palatal and tubal anatomy is discussed and a brief review of the relevant literature is given.     

Sonotubometry findings in children at high risk from middle ear effusion

The functioning of the eustachian tube has an important role to play in the development of middle ear disease. It would be useful if a clinical test could assist in the identification of eustachian tube dysfunction, particularly if this is shown to be an indicator of persistent middle ear effusion. The aim of this study was to compare the results of sonotubometry using the MMS-10 instrument in children at high risk from middle ear effusion with a group of normal subjects. Forty-one subjects (age range 5–6 years) were allocated to one of two groups (experimental group, 21 subjects; control group 20 subjects) based on a questionnaire designed to identify subjects at high risk from middle ear effusion. The test protocol allowed each subject to swallow three times for each of two pure-tones (7 and 8 kHz) delivered by the nasal probe. Sonotubometry indicated opening of the eustachian tube on swallowing in around 80% of subjects. The incidence of positive findings varied greatly amongst subjects across both groups. In the control group, the mean increase in sound pressure level on swallowing was 11.5 dB (± 4.3) and 9.8 dB (± 2.5) for 7 and 8 kHz, respectively. The corresponding means for duration were 118 ms (± 47.9) and 137 ms (± 61.8). Sonotubometry failed to demonstrate a difference between the two groups of subjects. Hence, the clinical application of sonotubometry to identify subjects at high risk from middle ear effusion is not supported.     

Effect of irradiation on middle ear effusion due to nasopharyngeal carcinoma

The management of middle ear effusion by myringotomy and insertion of ventilation tubes in 75 adult patients was evaluated. In Group 1 the middle ear effusion was not related to nasopharyngeal carcinoma. The patients with nasopharyngeal carcinoma were subdivided into pre and post-radiotherapy groups (Group 2 and Group 3) according to the time of insertion of the ventilation tubes. Myringotomy and insertion of ventilation tubes achieved significant hearing gain in all three groups. The pre and post-radiotherapy groups had a higher post-operative infection rate than Group 1 (P > 0.01). The duration of a persistent tympanic membrane defect in the post-radiotherapy group was significantly longer than Group 1 (P = 0.03). The post-radiotherapy group had more perforations than Group 1 (P= 0.02). A total of 28% of ears in the post-radiotherapy group were discharging at the last visit. In view of the higher complication rate in the post-radiotherapy group, the role of myringotomy and insertion of ventilation tube is reassessed.     

How effect is educational counseling prior to middle ear surgery for patients with both middle ear diseases and consistent tinnitus?

Abstract

Background: The management of patients with tinnitus who receive middle ear surgery has not been established.

Aims: The aim of this study is (1) how many patients who receive middle ear surgery have tinnitus and (2) how educational counselling and middle ear surgery is effective with consistent tinnitus.

Subjects and methods: Twenty four cases out of 90 cases accounted for 26.7% of the middle ear diseases scheduled for surgery in the past two years. Of the 42 patients with hearing loss in the second year, 14 had consistent and intermittent tinnitus. Among them we have 6 patients complaining consistent tinnitus and we examined the change in the Tinnitus Handicap Inventory (THI) for patients with tinnitus before and after surgery.

Results: Ten out of 13 cases (about 76.9%) reported that postoperative tinnitus improved. THI score in two cases showed worse.

Conclusions and significance: Two cases showed worse THI in both mixed hearing loss cases with a small hearing improvement. The mechanism of improvement is similar to tinnitus retraining therapy including hearing aid because the increase in external sound input through hearing restoration after surgery to avoid silence.     

软骨在中耳手术中的应用

自从Heermann[1-2]率先开始采用条栅状软骨技术修补鼓膜大穿孔后,软骨技术在中耳手术中的应用现已得到广泛承认。软骨的优点是取材方便,易存活;而且弹性好,不容易引起粘连,特别适用于鼓膜大穿孔、粘连性中耳炎、外耳道后壁重建、缩窄乳突术腔及其他复杂的术腔情况[3-11]。     

A blinded in‐vitro study to compare the efficacy of five topical ear drops in clearing grommets blocked with thick middle ear effusion fluid1

Objective: To compare the efficacy of 5% NaHCO₃, 3% H₂O₂, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid. Study design: A blinded in‐vitro study. Setting: District general hospital. Participants: A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients. Main outcome measures: Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection. Results: Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (χ² = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO₃, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H₂O₂ eardrops. Pair‐wise comparison was only significant for comparison between 5% NaHCO₃ and 3% H₂O₂ eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9–9.9). Conclusions: Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO₃ was the most efficacious and 3% H₂O₂ the least efficacious. Limitations of this in‐vitro study are recognized and a prospective in‐vivo double blind randomized controlled trial is planned.     

Test-retest variability of eustachian tube responses in children with persistent middle ear effusion

Summary In our previous studies on eustachian tube function in children with middle ear effusion, we found that many ears were evacuated by the act of sniffing. When subjects were tested repeatedly, however, responses to sniffing were very variable. In order to study the spontaneous variability, a total of 51 subjects (81 ears) were retested. The results of the retest were very similar to those of the first test when all the ears were considered as a group. However, in individual ears pronounced variability was seen. In the sniff test, responses changed qualitatively in 30% of the ears, and in 27% of the ears there was a change in the ability to equalize pressure by swallowing. Thus, the results of the group were highly reproducible, while at the same time individual results were highly variable with time.     

Temporal changes in unilateral middle ear pressure under basal conditions

Spontaneous changes in middle ear pressure were measured tympanometrically in 15 healthy adults over 7.5 h under basal conditions. Despite fluctuation of middle ear pressure no temporal pattern existed and there was no evidence of reciprocal changes in pressure between sides. When awake but at rest the middle ear pressure fluctuates around ambient pressure. Recordings of positive pressure may represent supportive evidence in favour of a net basal tendency to produce a positive middle ear pressure.     

Glomangioma of the middle ear

A 62-year-old female was admitted to our clinic in October 1999 with a 6-year history of hearing loss, tinnitus and otorrhea in the right ear. Physical examination showed a polypoid mass arising from the right middle ear and extending into the external auditory canal. Serohemorrhagic otorrhea was also observed. Serious hemorrhage occurred while taking a biopsy. The histopathologic diagnosis was a glomangioma. MRI demonstrated a hypervascular mass (10×15 mm²) completely filling the right middle ear. Preoperative embolization of the ascending pharyngeal artery was carried out. The tumor was completely resected via a transmastoid approach. No complications were observed postoperatively. At the most recent follow-up examination, 72 months after the operation, no sign of disease was present. The modified radical mastoidectomy approach used in this case proved to be a safe and efficacious method for removing the glomangioma.     

Inflammatory effects of otic drops on the middle ear

Combination topical otic preparations are used to treat many infections of the external and middle ears. Despite the presence of ototoxic drugs in a number of these drops and convincing evidence of sensorineural hearing loss in humans and animal studies (Meyerhoff et al., presented at Southern Section Triological Meeting, Jan. 1983) following use of these medications, otic drops remain the cornerstone of treatment for many infectious disorders of the ear. Twelve chinchillas underwent bilateral tympanostomy tube placement and daily instillation of Cortisporin Otic Suspension (polymyxin B, neomycin, hydrocortisone, propylene glycol) in the right external auditory canal for 7 consecutive days. The animals were sacrificed 3 days later, 10 days following initiation of the Cortisporin Otic Suspension treatment. Following routine preparation of the temporal bones for light microscopy, the tissue was evaluated for evidence of inflammatory changes. All 12 animals demonstrated granulation tissue, effusion and focal hemorrhage in the ears subjected to the Cortisporin Otic Suspension. All of the contralateral control ears were normal. The present data suggest that this inflammatory response is due to a topical irritant effect of the otic preparation.     

Primary cultures of middle ear epithelial cells from chinchillas

Summary A reproducible method is presented for primary cultures of middle ear epithelial cells (MEEC) from chinchillas. The MEEC were first dissociated with protease and grown on collagen-coated membrane using a culture medium containing equal volumes of Dulbecco's modified Eagle medium and Ham's F12 supplemented with 0.5% fetal bovine serum. Outgrowth of cells was first noted within 24 h, reaching confluency in 6–7 days. These cells grew in a monolayer and appeared to be ovoid or polygonal. By immunofluorescence microscopy, these cells stained for cytokeratin, but not for type III collagen. In contrast, fibroblasts stained for type III collagen, but not for cytokeratin. Based on growth characteristics, morphology, and immunofluorescent findings, these cells were determined to be epithelial cells. To retard the outgrowth of fibroblasts, 5 mM putrescine was added to the culture medium on the 2nd day of explant. Contamination with fibroblasts was consistently less than 5% when defined as type III collagen-positive cells. Establishment of a method for the primary culture of MEEC will provide a new approach for studying the role of epithelial cells in the pathogenesis of various types of otitis media.     

Standardized measurements of the sound transmission of middle ear implants using a mechanical middle ear model

Several ways to evaluate the sound transmission properties of middle ear implants are now established. Besides computer-based simulations using acoustic and electrical analog circuits or finite element analysis, measurements can be performed with temporal bone preparations. Experiments with these preparations consider various anatomical properties, but a large number of parameters influence the outcome of measurements. To facilitate standardized measurements, a mechanical middle ear model was developed that allows comparison of the transfer function of middle ear implants on defined conditions. The model approximates the impedances of the tympanic membrane and inner ear with the aid of thin, flexible membranes. The implants are fit between the membranes, and displacement at an artificial stapes footplate is measured with an optical probe. Fundamental influences on the sound transmission properties of nine different middle ear implants (total ossicular replacement prostheses) were examined. Although the material and shape were different, some of the prostheses revealed very similar transfer functions. The mass of the implant showed the largest influence on sound conduction. With a higher mass, the frequency area above approximately 1 kHz was found to be significantly deteriorated. The lightest implant used was 4 mg and showed the best overall results. These findings show that middle ear prostheses should be as light as possible for optimum high-frequency transmission. Received: 24 May 1998 / Accepted: 9 July 1998     

Middle ear status – structure,function and pathology: A scoping review on middle ear status of COVID-19 positive patients

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic is the latest public health emergency that has presented challenges globally. Limited evidence exists on the association between COVID-19 and middle ear pathologies, regardless of the respiratory nature of some of the core symptoms.ObjectiveThis scoping review aimed at exploring evidence on the effects of COVID-19 on middle ear functioning as part of symptom mapping and preventive planning for ear and hearing care.MethodElectronic bibliographic databases, including Medline, ProQuest, PubMed, Science Direct, ERIC and Scopus, were searched to identify peer reviewed publications, published in English, between December 2019 and January 2022, related to the effects of COVID-19 on middle ear functioning. The keywords used as MeSH terms included ‘middle ear pathology’, ‘middle ear disorder’, ‘otitis media’, ‘hearing loss’, ‘hearing impairment’, ‘audiology’ and ‘COVID-19’ or ‘coronavirus’.ResultsFrom eight studies that met the inclusion criteria, the findings revealed that middle ear pathologies occur in this population, with the occurrence ranging from 1.15% to 75%. Tympanic membrane structural changes, otitis media and conductive hearing loss (CHL) were commonly reported. The current findings must be interpreted with caution given that most of the studies reviewed had extremely small sample sizes or were case studies or series, thus limiting generalisability.ConclusionThe findings highlight the value of strategic research planning to collate data during pandemics, ensuring that future studies use appropriate and well-designed methodologies. Trends and patterns of middle ear pathologies in this population must also be established to determine the need for periodic monitoring.