耳内镜下经鼓室口行咽鼓管球囊扩张治疗伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍的临床研究

目的 对伴有慢性化脓性中耳炎的延迟开放型咽鼓管功能障碍（ETD）患者,在实施中耳乳突手术的基础上联合行耳内镜下咽鼓管鼓室口球囊扩张术,以探讨耳内镜下治疗的有效性。方法 选取2016年2月-2021年2月来该院就诊的伴有慢性化脓性中耳炎的延迟开放型ETD患者50例,按随机分配原则分为观察组和对照组,各25例。观察组采用中耳乳突手术联合耳内镜下咽鼓管鼓室口球囊扩张术,对照组采用中耳乳突手术联合鼻内镜下咽鼓管咽口球囊扩张术。比较两组患者术前及术后1年咽鼓管功能障碍评分（ETDQ-7）及术后复发率。结果 两组患者组内术前与术后1年ETDQ-7评分比较,差异有统计学意义（P <0.05）。观察组术后乳突腔引流通畅,未出现脓性渗出液。观察组术后1年复发率明显低于对照组,两组患者比较,差异有统计学意义（P <0.05）。结论 对伴有慢性化脓性中耳炎的延迟开放型ETD患者,在实施中耳乳突手术的基础上,行耳内镜下咽鼓管鼓室口球囊扩张术,较行鼻内镜下咽鼓管咽口球囊扩张术更加安全,且术后复发率低,效果更好。故在可能的情况下,对伴有慢性化脓性中耳炎的延迟开放型ETD患者行中耳乳突手术联合耳内镜下咽...     

Intracranial cholesteatoma: a case report and review

A cholesteatoma can be a complication of ear infection, eustachian tube dysfunction, prior ear surgery, or tympanic membrane perforation. It is typically associated with otorrhea and conductive hearing loss; sensorineural hearing loss, dysequilibrium, facial nerve paralysis, and altered mental status signify advanced disease. The treatment is surgical and recurrences are common. A case of cholesteatoma is presented that was associated with extension into the posterior fossa and presented with only a headache and localized pain.     

咽鼓管表面活性物质对气压损伤豚鼠中耳及听阈的影响

目的探讨人工咽鼓管表面活性物质(Eustachiantube surfactant,ETS)对气压损伤性中耳炎(Barotitis media,BM)的治疗作用,为临床应用提供理论依据.方法经低压舱上升实验建立气压损伤性中耳炎动物模型.成功建模豚鼠30只,于建模后的第1天,左侧中耳内注入1 mL人工ETS治疗,右侧对照注入1 mL生理盐水.结果1周后观察比较两组鼓膜状况(χ2=8.801,P＜0.05)、鼓室渗出(χ2=9.796,P＜0.05)、听阈恢复(χ2=9.810,P＜0.05),人工ETS组明显好转,与生理盐水对照组差异有显著性意义.结论人工ETS对气压损伤性中耳炎具有治疗作用.     

Sports Injuries of the Ear

The author describes common sports injuries involving the ear. Such injuries include hematoma, lacerations, foreign bodies (tattoo), and thermal injuries. Ear canal injuries include swimmer's ear and penetrating injuries. Tympanum injuries include tympanic membrane perforations, ossicular discontinuity, eustachian tube dysfunction, temporal bone fractures and traumatic facial nerve palsy. Inner ear injuries include traumatic sensorineural deafness. The author emphasizes the management of these injuries.     

Efficacy of bactericidal/permeability-increasing protein in experimental otitis media with effusion in rats: a new therapy for mucosal infections

Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without signs or symptoms of acute infection and by persistent changes in the middle ear mucosa. These are mainly induced by gram-negative bacterial infection and dysfunction of the eustachian tube (ET). Gram-negative bacteria (GNB) contain lipopolysaccharide (LPS) in their outer membrane that is responsible for inflammatory reactions in the middle ear. In this study we investigated the therapeutic effect of a recombinant LPS-binding protein, bactericidal/permeability-increasing protein (rBPI21), on the repair of mucosal damage in rats with experimentally induced OME. OME was induced by obstruction of the eustachian tube in combination with LPS injection. Twelve weeks after OME induction, secretory cells in the tympanic orifice of the middle ear were increased from an average of 14 +/- 2 to 31 +/- 5, ciliated cells were decreased from 24 +/- 4 to 6 +/- 4, and the number of macrophages in the subepithelial layer increased from 13 +/- 4 to 27 +/- 3. A single dose of rBPI21 was administered directly into the middle ear cavity 2 weeks after the induction of OME. Histologic examination of the middle ear mucosa at 4 and 12 weeks after OME induction showed that mucosal changes were restored by rBPI21 treatment. These results demonstrate that the middle ear mucosa recovers from inflammatory changes associated with OME after treatment with rBPI21. This suggests that rBPI21 may be useful in the treatment of OME and of mucosal infections of the respiratory tract.     

Eya4-deficient mice are a model for heritable otitis media

Otitis media is an extremely common pediatric inflammation of the middle ear that often causes pain and diminishes hearing. Vulnerability to otitis media is due to eustachian tube dysfunction as well as other poorly understood factors, including genetic susceptibility. As EYA4 mutations cause sensorineural hearing loss in humans, we produced and characterized Eya4-deficient (Eya4(-/-)) mice, which had severe hearing deficits. In addition, all Eya4(-/-) mice developed otitis media with effusion. Anatomic studies revealed abnormal middle ear cavity and eustachian tube dysmorphology; thus, Eya4 regulation is critical for the development and function of these structures. We suggest that some human otitis media susceptibility reflects underlying genetic predisposition in genes like EYA4 that regulate middle ear and eustachian tube anatomy.     

腺样体消融术同期咽鼓管球囊扩张术治疗儿童慢性分泌性中耳炎伴咽鼓管功能障碍的短期疗效

目的 观察腺样体消融术同期咽鼓管球囊扩张术治疗儿童慢性分泌性中耳炎伴咽鼓管功能障碍的短期疗效.方法 选择本院2019年1月至2020年5月收治的96例慢性分泌性中耳炎伴咽鼓管功能障碍患儿为研究对象,随机将其分为对照组与观察组,各48例.对照组采取腺样体消融术治疗,观察组采取腺样体消融术同期咽鼓管球囊扩张术治疗.观察并比...     

CME credit quiz

When a patient complains of a “plugged” ear, the eustachian tube Is often assumed to be congested, However, it may be abnormally patent. By otoscopic observation of the tympanic membrane while the patient performs simple maneuvers, the physician may be able to detect abnormal patency.     

A new minimally invasive method for the transtubal,microendoscopic application of fluids to the middle ear

The Eustachian (or auditory) tube is of central importance for the regulation of ambient air pressure changes within the middle ear spaces. Dysfunction of the Eustachian tube usually leads to chronic inflammatory changes of the middle ear.

The aim of the present feasibility study was to investigate an alternative, minimally invasive approach for the application of fluids to the middle ear via the Eustachian tube. This so‐called transtubal application (TTA) was conducted in a prospective, non‐randomized study with a total of ten subjects. The TTA approach consisted of placing a microendoscope within the Eustachian tube under local anaesthesia via its epipharnygeal opening. Subsequently, fluids were applied through an additional working channel after microendoscopic evaluation. Therefore the subjects were positioned supine‐laterally and had to swallow actively. The successful fluid application into the middle ear was evidenced by microendoscopy of the tympanic membrane (visualization of the fluid level). In all cases, a successful application could be evidenced. Side effects (e.g. pain, mucosal injuries, microbleedings) were not observed.

This new technique (TTA) offers the opportunity of a minimally invasive approach to treat tubal dysfunction and possibly other middle ear diseases by local fluid and/or drug application.     

3种方法治疗顽固性分泌性中耳炎的疗效研究

目的 探讨Nd：YAG激光鼓膜造孔术、鼻内镜下咽鼓管置管术及咽鼓管吹张术治疗顽固性分泌性中耳炎的疗效。方法 回顾性分析84例顽固性分泌性中耳炎患者治疗情况。其中26例施行Nd：YAG激光鼓膜造孔术治疗，为激光组；28例施行鼻内镜下咽鼓管置管术治疗，为置管组；30例施行传统的咽鼓管吹张术治疗，为对照组。比较3组疗效。结果 无论是激光组还是置管组，其治愈率及总有效率均明显高于对照组（P<0.05），且激光组的治愈率及总有效率明显高于其余2组（P<0.05）。结论 Nd：YAG激光鼓膜造孔术与鼻内镜下鼓膜置管术均为治疗顽固性分泌性中耳炎的良好方法，且Nd：YAG激光鼓膜造孔术更具有微创、安全、简单、疗效好等特点。     

Tympanometry

Tympanometry provides useful quantitative information about the presence of fluid in the middle ear, mobility of the middle ear system, and ear canal volume. Its use has been recommended in conjunction with more qualitative information (e.g., history, appearance, and mobility of the tympanic membrane) in the evaluation of otitis media with effusion and to a lesser extent in acute otitis media. It also can provide useful information about the patency of tympanostomy tubes. Tympanometry is not reliable in infants younger than seven months because of the highly compliant ear canals of infants. Tympanogram tracings are classified as type A (normal), type B (flat, clearly abnormal), and type C (indicating a significantly negative pressure in the middle ear, possibly indicative of pathology). According to the Agency for Healthcare Research and Quality guidelines on otitis media with effusion, the positive predictive value of an abnormal (flat, type B) tympanogram is between 49 and 99 percent. A type C curve may be useful when correlated with other findings, but by itself it is an imprecise estimate of middle ear pressure and does not have high sensitivity or specificity for middle ear disorders.     

耳内窥镜检查在中耳手术中的应用

目的：观察耳内窥镜检查在中耳手术中的应用。方法：５５耳中耳疾病患者，其中单纯型慢性化脓性中耳炎１５耳，胆脂瘤型化脓性中耳炎２５耳，分泌性中耳炎１５耳。分别在手术中及前、后进行耳内窥镜检查。结果：耳内窥镜检查能观察到手术显微镜不易观察到的部位，如：上鼓室、后鼓室、鼓窦入口、咽鼓管鼓口等，易于发现中耳病变，降低病变复发率。结论：耳内窥镜检查为中耳显微手术提供了良好的辅助手段。     

咽鼓管球囊扩张术治疗难治性分泌性中耳炎的疗效分析

目的评价咽鼓管球囊扩张术治疗难治性分泌性中耳炎的效果。方法对15例24耳诊断为难治性分泌性中耳炎患者进行咽鼓管球囊扩张术。患者纳入标准:鼓膜切开置管≥3次,病程超过2年迁延不愈的中耳炎。主要评价指标包括主观症状改善、耳内镜检查、纯音听力测试、声阻抗和CT扫描。结果所有患者成功接受手术。术后8~24个月复查,手术前后患者主观症状、耳内镜检查、CT扫描有效率95.8%。手术后10~24个月纯音听阈测试患耳术后言语频率气导听力较术前提高(P0.05),术前患耳平均气骨导差为36.15 d B,患耳术后平均气骨导差为14.35 d B(P0.05)。术后鼓室导抗图达到A型为83.3%。1例(1耳)术后自觉患侧听力无提高,耳内闷胀感,B型鼓室导抗图,行乳突轮廓化联合鼓膜置管术见中耳及乳突有肉芽样胆固醇结晶。结论咽鼓管球囊扩张术治疗难治性分泌性中耳炎的疗效显著,难治性分泌性中耳炎可能是咽鼓管球囊扩张术的最佳适应证之一。     

Acute otitis media: Part I. Improving diagnostic accuracy

Acute otitis media is overdiagnosed. Symptoms are neither sensitive nor specific for the diagnosis of otitis media; fever and ear pain are present in only one half of patients. Undue reliance on one feature--redness of the tympanic membrane--and failure to assess tympanic membrane mobility with pneumatic otoscopy contribute to inaccurate diagnoses. Adequate visualization of the tympanic membrane is often impaired by low light output from old otoscope bulbs and blockage of the ear canal by cerumen. Distinguishing acute otitis media from otitis media with effusion is clinically important because antibiotics are seldom indicated for the latter condition. A key differentiating feature is the position of the tympanic membrane: it is usually bulging in acute otitis media and in a neutral position or a retracted position in otitis media with effusion. Tympanometry and acoustic reflectometry can be useful adjunctive tools to confirm the presence of fluid in the middle ear. Selective use of tympanocentesis in cases of refractory or recurrent middle ear disease can help guide appropriate therapy and avoid unnecessary medical or surgical interventions.     

Immitance audiometry

Immitance audiometry is a safe, simple, reliable, and relatively objective method of determining middle-ear function that provides advantages for examining the difficult patient because minimal cooperation is needed. Acoustic-immitance measurements obtain sophisticated data that give us valuable information about the middle ear mechanism as a whole. It can be used in a quiet office environment. Immitance audiometry can confirm a doubtful otoscopic diagnosis and screen for ear disease. There are limitations to observer reliability with otoscopy, which has good sensitivity but poor specificity, in contrast to immitance audiometry. The tympanogram can be classified into four different patterns on the basis of its characteristics. These patterns are diagnostic, distinguishing normal function from various types of middle ear pathology. Immitance audiometry has very high sensitivity and specificity. The acoustic reflex, a contraction of the stapedius muscle following an intense auditory stimulus, can be valuable in determining a conductive hearing loss and many other otologic diagnoses. As a screening tool, immitance audiometry is most valuable in populations at risk for middle ear effusion, primarily those aged 7 months to 5 years. Significant improvements in measurements of ear function also allow us to be more precise in the diagnoses of otosclerosis, perforation of the tympanic membrane, ossicular discontinuity, facial nerve dysfunction, and brain stem disorders.     

Office-based CO2 laser-assisted tympanic membrane fenestration addressing otitis media with effusion

OBJECTIVE: To use the CO2 laser-assisted tympanic membrane fenestration in office settings, under local anesthesia, as the sole treatment for patients with chronic otitis media with effusion (OME). BACKGROUND DATA: This new treatment ensures artificial ventilation of the middle ear for several weeks, and provides an intermediate solution between ordinary lancet-made tympanocentesis and transtympanic ventilation tube insertion. The operative technique is already well codified, and preliminary studies have demonstrated that tympanic membrane fenestration does not expose patients to any major hazard. METHODS: We treated 30 ears in 21 children and 29 ears in 24 adults. All patients had presented with OME persistent for more than 3 months. The laser tympanostomy was performed under local anesthesia, as an outpatient procedure, using a CO2 flash-scanning laser in conjunction with a handpiece (OTOLAM). Using a power of 12 W to 17 W, a single laser pulse usually sufficed to create a 2-mm-diameter circular perforation in the anteroinferior quadrant of the eardrum. RESULTS: The tympanic membrane fenestration allows avoiding ventilation tube insertion in 63% of children and 75% of adults. CONCLUSIONS: The CO2 laser-assisted tympanic membrane fenestration seems a valid therapeutic option addressing OME. This study should be pursued on a larger scale to define more precisely the indications of the laser tympanostomy.     

慢性中耳乳突炎侵犯鼓室骨壁的HRCT探讨

目的:着重研究慢性中耳乳突炎侵犯鼓室壁的HRCT特征及其临床价值。材料和方法:收集经临床和手术证实的慢性中耳乳突炎28例计32耳,并伴有鼓室壁损害的HRCT资料,回顾性分析影像学表现,评价临床意义。结果:①鼓室盖异常68耳,占25%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损5耳;②颈动脉管异常6耳,占18.7%。其中,骨质疏松2耳,骨壁缺损1耳;③颈静脉孔壁异常5耳,占15.6%。其中,骨质疏松2耳,骨壁菲薄1耳,骨壁缺损2耳;④乙状窦骨壁异常13耳,占40.6%。其中,乙状窦骨壁缺损3耳,乳突窦骨壁破坏10耳,听小骨糜烂、移位5耳;⑤骨迷路异常7耳,占21.8%。其中,鼓岬缺损1耳,前庭窗模糊1耳,蜗窗缺损2耳,面神经管缺损2耳,外半规管缺损1耳;⑥鼓膜异常21耳,占65.6%。其中,鼓膜缺损7耳,鼓膜增厚7耳,鼓膜内陷5耳,外耳道骨质破坏2耳。结论:运用HRCT扫描横断位和冠状位相结合,除能显示慢性中耳乳突炎病变表现外,还能确定其鼓室各壁的骨质损害部位、程度及与周围结构的关系,对手术处理具有重要意义。     

Investigation of middle ear anatomy and function with combined video otoscopy-phase sensitive OCT

We report the development of a novel otoscopy probe for assessing middle ear anatomy and function. Video imaging and phase-sensitive optical coherence tomography are combined within the same optical path. A sound stimuli channel is incorporated as well to study middle ear function. Thus, besides visualizing the morphology of the middle ear, the vibration amplitude and frequency of the eardrum and ossicles are retrieved as well. Preliminary testing on cadaveric human temporal bone models has demonstrated the capability of this instrument for retrieving middle ear anatomy with micron scale resolution, as well as the vibration of the tympanic membrane and ossicles with sub-nm resolution.OCIS codes: (170.4940) Otolaryngology, (110.4500) Optical coherence tomography, (120.5050) Phase measurement, (120.7280) Vibration analysis     

Cerumen Occlusion Lowers Infrared Tympanic Membrane Temperature Measurement

Objective: To examine the effect that cerumen occlusion of the ear canal has on infrared tympanic membrane temperature measurement.
Methods: A prospective, randomized, single-blind human study was carried out in a university hospital observation unit. The subjects were a convenience sample of human volunteers aged 18 years or older who did not have cerumen occlusion or scarred tympanic membranes. A paraffin-coated human cerumen plug was placed in one randomly chosen ear, and after 20 minutes of equilibration the temperature in each ear was measured with an infrared thermometer. Analysis of the difference in mean temperature between the occluded and nonoccluded ears was by Student's paired t-test.
Results: Infrared tympanic membrane temperatures were measured in 43 subjects aged 21 to 58 years. The mean temperature of the occluded ear canal was 0.3°C lower than that of the opposite ear canal (p = 0.0001, 95% CI 0.16–0.45°C).
Conclusion: Cerumen occlusion of the ear canal causes underestimation of body temperature measured by infrared tympanic membrane thermometry.