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     

Effects of inflammatory changes in the middle ear mucosa on middle ear total pressure

Conclusions. Inflammation of the middle ear mucosa leads to inhibition of transmucosal carbon dioxide (CO₂) diffusion. Furthermore, CO₂ diffusion is inhibited more severely in ears with a histologically higher grade of inflammation. Objectives. To investigate the effect of inflammatory changes in the middle ear mucosa on transmucosal gas exchange, and the relationship between the histologic inflammation grade of the middle ear mucosa and the middle ear total pressure (METP). Materials and methods. Twenty-six rabbits were used for this study. Changes in the METP and the oxygen partial pressure in the middle ear (PmO₂) were measured in the otitis media group and the untreated group, and were compared between the two groups. Inflammatory changes in the middle ear mucosa were classified into four grades histologically, and the relationship between the histologic inflammatory grade and the maximum METP was examined. Results. The maximum METP in the otitis media group was significantly decreased compared with the untreated group (p<0.05), but there was no difference between the two groups in the rate of decrease of the PmO₂. Furthermore, the maximum METP in grade III inflammation was significantly decreased compared with that in grade II inflammation (p<0.05).     

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.     

The effects of middle ear muscle contraction on auditory and overload thresholds

The present investigation examined psychophysically the frequency-specific and nonlinear attenuation of sound energy provided by middle ear muscle contraction in normal hearers. Aural overload and absolute auditory thresholds were measured at 500, 1 000 and 2 000 Hz prior to and during acoustic stapedial reflex contraction. Reflex contraction was elicited with contralateral broad-band noise. Results revealed that over-load thresholds were elevated at 500 and 1 000 Hz and a slight decrease in overload threshold was apparent at 2 000 Hz during reflex contraction while absolute thresholds remained essentially unchanged. These data are consistent with previous psychophysical and physiological findings. The aural overload test having been derived directly from observations of cochlear microphonic saturation, moreover, affords direct comparison to results of electrophysiological experimentation.     

中耳胆固醇肉芽肿

目的 探讨中耳胆固醇肉芽肿的病因、发病机制以及治疗方法。方法 回顾性总结分析我院1988年3月～2003年3月经手术和病理证实的70例(耳)中耳胆固醇肉芽肿病人的临床资料。70例(耳)中，术前诊断为胆脂瘤型中耳炎37例，骨疡型中耳炎13例，此二者之中考虑胆固醇肉芽肿者13例；中耳乳突术后感染5例，分泌性中耳炎7例，特发性血鼓室8例，其中考虑可能为胆固醇肉芽肿者2例。所有病人均有不同程度听力下降、耳闭塞感或伴耳鸣，亦可有耳溢液、头痛、头昏及其他症状。70例(耳)均接受手术治疗，依照术前检查，根据病变程度不同而选择不同术式。结果 65例(耳)干耳，随访1年以上无复发。3例(耳)行改良乳突根治加鼓室成形术，术后半年流脓，后改行乳突根治术，术后均干耳；2例(耳)行鼓室探查加鼓窦开放术，术后半年及1年又流脓伴听力下降，后改行改良乳突根治加鼓室成形术，术后干耳。结论 中耳胆固醇肉芽肿的病因主要有：含气腔通气受阻、引流障碍及含气腔出血。中耳胆固醇肉芽肿与特发性血鼓室、分泌性中耳炎及胆脂瘤关系密切。术式的选择应根据病变范围和程度来决定，其原则是彻底清除病变，保持通畅引流。     

慢性鼻窦炎病理因素对中耳功能影响的评价

目的 探讨慢性鼻窦炎对中耳功能的影响.方法 53例慢性鼻窦炎患者和10例健康成人,分别进行声导抗检查和纯音测听,采用多状态Logistic回归模型评价慢性鼻窦炎影响中耳功能的可能因素.结果 本组慢性鼻窦炎患者中,鼓室导抗图A型33例（62.26%）,As型4例（7.55%）,B型2例（3.77%）,C型14例（26.42%）;听力检查示正常听阈35例（66.04%）,轻度聋16例（30.19%）,中度聋2例（3.77%）.经过Logistic回归分析,最后确定了2项可能影响患者的鼓室导抗图和纯音听阈的因素,即筛窦的CT分型呈硬化型和提示病情较重的鼻窦炎临床分型和分期.结论 慢性鼻窦炎可影响中耳功能,尤其是筛窦呈硬化型、病变分型分期提示疾病病情重时,效应最为明显.     

Changes in tympanograms after middle ear inflation

Summary To determine the effects of politzerization or middle ear (ME) inflation by a catheter, we studied the membranes (29 patients). Serial tympanometries were performed prior to the ME inflation and immediately, 10, 20, 30 and 60 min after the procedure. The present study showed that the more negative the ME pressure was before the inflation, the greater the pressure change was after the treatment. The elevated ME pressure induced by the procedure declined rapidly within the first 20 min after the inflation. This was probably caused mainly by spontaneous elimination of ME gas through the eustachian tube and gas absorption from the ME mucosa. During the post-inflation course, some ears demonstrated more negative pressures in the ME cavity than those before the inflation. The present investigation demonstrated that the use of inflation to treat secretory otitis media had short-term benefits which could be improved by minimizing gas absorption.     

Effects of desflurane on middle ear pressure

OBJECTIVE: To evaluate the effects of desflurane on middle ear pressure. STUDY DESIGN: A prospective clinical study. METHODS: In this study, 38 ears of 19 male children that were scheduled for circumcision were included. Baseline tympanometry reading was performed on each ear just before anesthesia. After induction anesthesia with propofol a laryngeal mask was applied and desflurane administration was started. The next tympanometry reading was taken at 5th, 10th and 15th minute after administration and at the 10th minute after the cessation of desflurane. Data were analysed using Wilcoxon test. RESULTS: Mean MEP values before anesthesia in 38 ears of 19 boys were -10.32+/-33.14. After starting the administration of desflurane 5th minute mean value was 71.15+/-60.42, at the 10 th minute 111.56+/-59.03 and at the 15th minute it increased to 120.50+/-54.14, and these measurements were significantly higher than the starting value (p<0.001). After cessation of desflurane mean MEP value dropped to 57.56+/-79.06, but compared with the starting value this was also significantly higher (p<0.001). CONCLUSION: Desflurane may increase the middle ear pressure and it may be unsuitable for certain middle ear surgeries.     

中耳内窥镜解剖

目的 :探讨经不同途径的中耳内窥镜解剖所见。方法 :采用 0°,30°,90°的硬质内窥镜 ,对 17个颞骨标本进行了观察 (其中干标本 6个 ,湿标本 11个 ) ,内窥镜插入途径有 :外耳道 ;耳后切口 (包括乳突腔 鼓窦和乳突腔 后鼓室两条亚途径 ) ;中颅窝。结果 :外耳道途径 :采用 0°,30° ,90°的硬质内窥镜 ,所有鼓室结构都可看见 ,包括鼓室窦、面隐窝、上鼓室前隐窝等隐蔽处 ;乳突腔 鼓窦途径 :可以看见乳突腔、鼓窦、上中鼓室等结构 ;乳突腔 后鼓室途径 :可观察到乳突及中下鼓室结构 ;中颅窝途径 :可以观察到上鼓室、鼓窦、乳突腔及鼓室外侧壁的结构 ,中鼓室的大部分结构亦可观察到。结论 :经不同的途径行内窥镜术能清楚地观察到中耳各个结构 ,因此能减少胆脂瘤的复发率及评价术后中耳腔的状态 ,其中 30°的内窥镜提供的视野较好 ;但如经外耳道途径观察后上鼓室及经乳突腔 鼓窦途径观察后鼓室 ,则 90°内窥镜较适合     

先天性中耳胆脂瘤

目的探讨先天性中耳胆脂瘤的位置、范围、临床症状、影像学特征及手术治疗。方法本文回顾性分析了解放军总医院耳鼻咽喉-头颈外科自1995年1月～2005年10月诊治的952例胆脂瘤患者的治疗结果,对其中10例先天性中耳胆脂瘤的起源、临床特征及手术前后的听力进行了评估。结果10例先天性中耳胆脂瘤患者的平均年龄为16岁(10～24岁),其中7例为男性,3例为女性,出现症状到临床确诊的平均时间为2年。术前平均纯音听阈为55dB,平均气-骨导差为45dB,有2例患者的鼓膜像上可以看到典型的先天性中耳胆脂瘤表现。所有病例均进行了高分辨率颞骨CT扫描。8例术前分别被诊断为耳硬化症或听骨链畸形。所有病例都在外耳道径路鼓室探查清除胆脂瘤后进行了一期鼓室成型术,除了1例因为病变广泛选择了完壁式乳突根治和鼓室成型术。本组所有病例的胆脂瘤均位于中-后鼓室,主要是在砧镫关节处。术后的平均气-骨导差小于20dB。所有病例术后至少随访1年半,2例病人因为术后听力下降进行了二期手术。本组病例中经手术探查或CT复查,没有发现胆脂瘤残留或复发。结论原发性中耳胆脂瘤临床罕见,常被延误诊断,其预后和残留、复发比例主要决定于病变范围。     

中耳恶性肿瘤33例临床分析

目的探讨中耳恶性肿瘤的临床特点和治疗策略。方法回顾性分析解放军总医院1997～2007年经治的33例中耳恶性肿瘤患者,其病理类型分别是25例鳞状细胞癌．5例腺癌,2例粘液表皮样癌及1例横纹肌肉瘤。结果按照Stell分期为Ⅰ期2例,Ⅱ期12例,Ⅲ期19例。8例行扩大的乳突根治术,19例行颢骨次全切除术,6例接受颞骨全切除术。以阔筋膜修复缺损的硬脑膜,以胸大肌皮瓣、胸锁乳突肌瓣、颞肌瓣等单独或联合修复术腔缺损。1例患者单独接受手术治疗,32例患者接受手术＋放疗的综合治疗。全组总的3年、5年生存率分别是85．2％、74．7％。有血性耳漏患者与无血性耳漏患者的3年生存率分别是74．1％和89．1％（P=0．049）。结论对中耳恶性肿瘤的患者采取扩大切除加术后根治性放疗可提高生存率,持续的血性耳漏可能是预后不良的表现。     

Sugarcane biopolymer membrane: experimental evaluation in the middle ear

New developments on biomaterials are important in surgery. The behavior of a new membrane produced from sugarcane will be evaluated in the middle ear of rats.Aim: This study analyzed the results from the interaction of the sugarcane-base biopolymer membrane in the middle ear of a rat.Materials and Methods: We ran an experimental, prospective, paired study with 24 Wistar rats. The sugarcane-base polymer membrane was inoculated in the right ear; and an autologous fascia in the left ear. The rats were divided in 3 groups of 8, and slaughtered at 4, 8 and 12 weeks after surgery. Histological analyses were performed on the rats' middle ear mucosa and their tympanic membranes.Results: There was an inflammatory reaction on the experimental group and middle ear subacute exudate in 50%of the cases; 30% chronic exudate; and 20% was normal. In the control group there was only one case of exudate. The inflammation was initially described as intense, but it decreased over time. Myringosclerosis was observed in both groups. The sugarcane biopolymer membrane was absorbed later when compared with fascia.Conclusion: The sugarcane biopolymer membrane induced an inflammatory reaction in the middle ear which decreased over time, and mild fibrosis. Future studies can indicate its use in otolaryngology.     

Multiple osteomas in the middle ear

Osteomas in the middle ear are extremely rare and are generally solitary and small. We present a case of a 28-year-old female patient with multiple middle ear osteomas which arose from the promontory, epitympanum, and lateral semicircular canal. The osteomas were successfully removed by tympanomastoidectomy. This is the first reported case of a patient with middle ear osteomas arising from multiple sites.     

中耳先天性胆脂瘤1例

<正>中耳先天性胆脂瘤是少见疾病,常因病变隐匿而导致临床上延误诊断和治疗,随着影像学技术的提高和显微镜检查的普及,发现报道的先天性胆脂瘤病例逐渐增多。先天性胆脂瘤早期可无任何表现,逐渐出现传导性聋、耳痛,听力进行性下降,严重者可出现面瘫和神经性聋,甚至出现颅内并发症[1],由于无流脓、鼓膜穿孔等耳部症状,单侧的听力下降容易被忽略,诊断不易做出。现将解放军405医院耳鼻喉科2014年3月收治的先天性胆脂     

耳内镜下儿童中耳胆脂瘤的处理及疗效分析

目的 探讨耳内镜下经耳道径路切除儿童中耳胆脂瘤的手术适应证及临床疗效,为该类疾病的处理提供临床参考.方法 回顾性分析2017年9月-2020年10月上海交通大学医学院耳科学研究所耳内镜下经耳道径路处理的20例中耳胆脂瘤患儿临床资料,患者年龄3～14岁,平均年龄为(7±0.5)岁.根据术前影像学评估,病变范围均在中耳范围...     

罕见中耳巨大胆脂瘤1例

中耳胆脂瘤是一种常见的慢性中耳疾病,特征是中耳腔、乳突腔及岩尖存在高度增殖的角化鳞状上皮和邻近骨质的破坏吸收,上皮细胞脱落、上皮碎屑堆积而形成胆脂瘤[1].现将我科收治的1例罕见巨大胆脂瘤病历资料报告如下.     

先天性内耳畸形并中耳畸形患者多通道人工耳蜗植入术3例报告

目的：探讨先天性内耳畸形并中耳畸形患者行多通道人工耳蜗植入术的方法及效果。方法：1995年5月-2002年5月我院为3例罕见的先天性内耳畸形并中耳畸形患者经乳突进路行人工耳蜗植入术,分别植入27、28、32个电极,植入后3个月行声场测听。结果：3例患者均成功地行人工耳蜗植入,术中、术后无严重并发症发生,术后声场测听听阈达35-40dBHL。结论：罕见的先天性内耳畸形并中耳畸形患者也可行人工耳蜗植入术,术后效果满意。     

Extending the chinchilla middle ear epithelial model for mucin gene investigation

Objectives

To investigate the expression of recently identified human mucin genes in an in vivo model of the chinchilla middle ear epithelium (CMEE).

Methods

CMEE was harvested, RNA was extracted and primers were designed for RT-PCR to assess for expression of mucin genes Muc6, Muc17 and Muc18. Further sequencing of these genes was also accomplished.

Results

Mucin genes Muc6, Muc17 and Muc18 was assessed and found to be identical to the expression in human and mouse MEE.

Conclusion

This study further characterizes mucin gene expression in the CMEE and provides additional sequence data for chinchilla middle ear genes. The concordance of this gene expression data to that of both the human and mouse models further demonstrates the utility of this animal model in OM investigations.     

腭裂修复术对中耳功能的影响

为研究腭裂修复术对中耳功能的影响，应用声导抗及耳镜检查，以４３例腭裂患者于腭理解修复术前及术后半年，进行分泌性中耳炎（ＳＯＭ）发病情况及中耳功能检测。资料显示：ＳＯＭ发病率术前为６１．６３％，≤９岁患儿发病率高于〉９岁患儿；腭裂类型对ＳＯＭ的发生率无影响；腭裂修复术后患者ＳＯＭ发病率有所下降，中耳功能较有均有明显改善２，表明腭裂患者ＳＯＭ发病率高，腭裂修复术能够使患者的中耳功能得到一定程度的改善。