Surgical anatomy of the human middle ear: an insight into cochlear implant surgery

Purpose

This research was designed to aid practical otologic studies of the human middle ear. The topographic anatomy access of the middle ear was described with special focus to the cochlear implant procedure. It was conducted in an attempt to elucidate factors that would ultimately determine the ease of insertion of an electrode array.

Methods

Fifteen right and 12 left temporal bones were dissected under the surgical microscope. After performing appropriate incisions, the distances between the stapedius muscle tendon, incus long crus and the cochleostomy were measured with the help of a digital microscope (Dino-Lite plus^?).

Results

After performing statistical analysis, we found that strong relationship exists in the distances between the measured anatomical landmarks.

Conclusion

Microscopic anatomical studies of the temporal bone are essential to safely perform surgical intervention within the middle ear. The results shows that morphometric data concerning different anatomical structures inside the middle ear, particularly distances, is an important contribution towards the planning of safe surgical procedures.     

Morphometric study of the external and middle ear anatomy in sheep: a possible model for ear experiments

Sheep are a potentially useful model for otologic surgical training and experimentation, currently limited by the scarcity of morphological comparisons between the structure of the ear in sheep and in humans. A detailed morphometric study of the ear in sheep was carried out using computed tomography. Measurements made with AutoCAD Release 14 were compared with measurements for the human ear reported in the literature. In general, ear structures in sheep are two-thirds the size of those in humans. The important anatomical similarities found in this study between the ear in sheep and in humans suggest that sheep may be a useful model for surgical training and experimentation in some middle ear procedures.     

Finite element analysis of the effects of a floating mass transducer on the performance of a middle ear implant

Experimental evidence has shown that floating mass transducers (FMTs) play a key role in the performance of middle ear implants. However, because of the tiny size and complex structure of the middle ear, systematic experimental study of the influences of FMTs is difficult to carry out. In this paper we develop a FMT-attached middle-ear finite element model to investigate some effects of a FMT on the performance of a middle ear implant. This model was constructed based on a complete set of computerized tomography section images of a healthy volunteer's left ear. The validity of the developed model was verified by comparing the model-predicted motion of the tympanic membrane and stapes footplate with published experimental data. The result shows that the FMT produces a mass loading effect prominently at high frequencies, the force required to drive the incus to the equivalent of 100 dB sound pressure level (SPL) is about 89?μN, and setting the attachment position of the FMT close to the incudostapedial joint can enhance the driving effect.     

Efficacy of nanoporous silica coatings on middle ear prostheses as a delivery system for antibiotics: An animal study in rabbits

Nanoporous silica layers are able to host molecules and release them over a certain period of time. These local drug delivery systems for antibiotics could be a new approach in the treatment of chronic otitis media. The aim of this study was to examine the efficacy of nanoporous silica coatings on middle ear prostheses as a delivery system for antibiotics in vivo. Pseudomonas aeruginosa was inoculated into the middle ear of rabbits to induce an otitis media. The control group received coated Bioverit®II implants without antibiotics. Coated prostheses with loaded ciprofloxacin were implanted into the middle ears of the study group. After 1 week, the rabbits were sacrificed. The clinical examination as well as the microbiological and histological examinations of organs and middle ear irrigation revealed clear differences between the two groups. P. aeruginosa was detected in every middle ear of the control group and was almost completely eliminated in the study group. Organ examinations revealed the presence of P. aeruginosa in the control group and a prevention of a bacterial spread in the study group. The nanoporous silica layer as antibiotic delivery system showed convincing efficacy in induced pseudomonal otitis media in the rabbit.     

The comparative anatomy of the pig middle ear cavity: a model for middle ear inflammation in the human?

This study was undertaken to develop a functional model of otitis media with effusion (OME) in the pig ( Sus scrofa ), with the purpose of investigating the origin of lymphocytes populating the middle ear during the course of an inflammatory process. The relevance of the model to the human condition of OME is to a large extent dependent on the anatomical and physiological similarities between the middle ear cavity and the pharyngeal lymphoid tissue of the pig and man. Anatomical specimens were collected from 7 young Large White pigs to determine the gross anatomy of the middle ear cavity and the histological characteristics of the middle ear mucosa. It was found that the anatomy of the 3 parts of the middle ear cavity in man and in the pig is broadly similar, although some minor differences were observed. The porcine eustachian tube was seen to be cartilaginous throughout its length in contrast to the part osseous, part cartilaginous structure found in man; the porcine ossicles were slightly different in shape to those of man and the air cell system was situated inferior to the tympanic cavity in the pig as opposed to posteriorly in man. This paper describes the structure and morphology of the pig middle ear cavity and compares and contrasts it with that of man. The minor differences observed are of anatomical importance but do not diminish the usefulness of the pig middle ear cleft as a potential model for human middle ear disorders.     

Design of an implantable active microport system for patient specific drug release

We present a novel concept of an implantable active microport based on micro technology that incorporates a high-resolution volumetric dosing unit and a drug reservoir into the space of a conventional subcutaneous port. The controlled release of small drug volumes from such an "active microport" is crucial e.g. for innovative methods in cancer treatment or pain therapy. Our microport system delivers a flow rate in the range of 10-1,000 mul/h and enables a patient-specific release profile. The core of our device is a two-stage piezoelectric micropump. It features a backpressure-independent volumetric dosing capability i.e. a stable flow rate is ensured up to a backpressure of 30 kPa. The stroke volume and hence the resolution of the mircopump is voltage controlled and can be preset between 10 and 200 nl. A miniaturized high-performance electronic control unit enables freely programmable dosing profiles. This electronic circuit is optimized for both energy consumption and weight which are both essential for a portable device. The data of an implemented pressure sensor are used to permanently monitor the dosing process and to detect a potential catheter occlusion. A polyurethane soft lithography process is introduced for the fabrication of the prototype. Therewith, a compact multilayer system has been developed which measures only 50 x 35 x 25 mm(3).     

An inexpensive alternative for recording middle ear muscle activity (MEMA) during sleep.

In past studies of middle ear muscle activity (MEMA) in sleep, one of two methods of recording has been used: an acoustic impedance bridge (AIB) or a miniaturized pressure transducer (MPT). A low-cost and less fragile piezoresistive pressure transducer was tested to determine its practicality in recording MEMA during sleep in humans. A specialized ear mold accommodating both types of pressure transducer was custom-fitted for six subjects. The sleep of each subject was analyzed epoch by epoch for one night to determine comparability of the two transducers. In no case did either transducer indicate a MEMA without confirmation by the other. It is recommended that this type of transducer would be practical for researchers interested in recording MEMA in sleep.     

正常中耳腔的CT仿真内窥镜技术

目的：探讨正常听骨链的CT仿真内窥镜(CTVE)成像技术方法及其对中耳结构显示程度。方法：15例无中耳疾病的健康人，层厚1mm、螺距1．0轴位薄层扫描，骨算法、0．1～0．2mm间隔重建，行CTVE成像，观察正常听骨链的情况。结果：采用CTVE技术，对锤骨、砧骨及锤砧关节及砧镫关节的显示率均能清晰的显示，砧镫关节呈“L”形。但镫骨底板和镫骨的前、后脚显示欠佳，约有1／3可以显示。结论：CTVE成像技术能很好地显示中耳腔内部的听骨链立体结构，特别是可以部分显示镫骨底板，该技术将在活体上对中耳腔形态及功能的研究有重要意义。     

Poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) as an injectable implant system for prevention of post-surgical tissue adhesion

An injectable implant system that immediately forms a film around the injection site of an animal was successfully developed by dissolving microbial polyester poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) in not harmful organic solvents including N-methyl pyrrolidone (NMP), dimethylacetamide (DMAC), 1,4-dioxane (DIOX), dimethyl sulfoxide (DMSO) and 1,4-butanolide (BL), respectively. The formation of the PHBHHx film was the result of contact between aqueous body fluids and the amphiphilic PHBHHx solvents, leading to the controllable precipitation (film formation) of PHBHHx around the contact site. The resultant PHBHHx film assumed the shapes of its surrounding cavities. The resulting porous PHBHHx film was not favorable for attachment of Human Embryo Lung Fibroblast (HELF) cells. As a consequence, the fibroblasts cultured on the PHBHHx film exhibited a spheroid-like morphology. It was found that hydrophilicity of the PHBHHx film prepared using the above technique was significantly reduced compared with the poly(lactic acid) (PLA) film prepared for the same purpose and a PHBHHx film prepared from chloroform casting. This reduced hydrophilicity explains the poor attachment of fibroblast cells to the injectable PHBHHx film, suggesting that the PHBHHx injectable implant system can be developed as a tissue adhesion prevention film for surgical operations.     

Design and development of an automatic data acquisition system for a balance study using a smartcard system

For measurement value logging of board angle values during balance training, it is necessary to develop a measurement system. This study will provide data for a balance study using the smartcard. The data acquisition comes automatically. An individually training plan for each proband is necessary. To store the proband identification a smartcard with an I2C data bus protocol and an E2PROM memory system is used. For reading the smartcard data a smartcard reader is connected via universal serial bus (USB) to a notebook. The data acquisition and smartcard read programme is designed with Microsoft® Visual C#. A training plan file contains the individual training plan for each proband. The data of the test persons are saved in a proband directory. Each event is automatically saved as a log-file for the exact documentation. This system makes study development easy and time-saving.     

The biocompatibility of hydroxyapatite ceramic: a study of retrieved human middle ear implants

The biocompatibility of 11 hydroxyapatite auditory canal-wall prostheses and 4 hydroxyapatite incus prostheses implanted for 4 to 40 months was evaluated by light microscopy, scanning electron microscopy, transmission electron microscopy, and R?ntgen microanalysis. These 15 prostheses representing 4% of 375 prostheses, has been removed because of unresolved chronic middle ear infection, residual cholesteatoma, or poor fit. The findings confirmed earlier reports on the biocompatibility of hydroxyapatite in vitro, in animals, and in man. An electron-dense layer was found at the interface with bone and fibrous tissue, and a firm bond between the ceramic and bone at the hydroxyapatite ceramic/bone interface developed. Macropores became filled with bone and fibrous tissue, and the tissue in the individual pores was interconnected. Furthermore the incus prostheses were covered with an epithelium similar to that found in the human middle ear. Findings diverging from those made in other studies were the relatively large amount of exudate in the pores, an apparent increase of degradation during infection, and the accumulation of trace elements in one of the canal-wall prostheses. In all likelihood these three phenomena may be attributed to the unfavorable conditions to which these prostheses were exposed during implantation.     

Design of a noninvasive and smart hand tremor attenuation system with active control: a simulation study

This paper presents the design and simulation of a handheld device for people with hand tremor, such as Parkinson’s and essential tremor patients. This device can be used as a pen for smartphones or as a spoon. The designed system includes two links, which are connected to two servomotors, which are mounted in orthogonal directions. To attenuate the effect of hand tremor on the tip of device, PID and computed torque methods are used to actively control the system. These controllers are used to control the rotation of the motors for moving the links in opposite directions of the hand tremor. Performance of the device with mentioned controllers is studied for different applications and finally, the results of both controllers are discussed and compared. Based on the presented results in this study, the designed device is able to suppress the hand tremor up to 75% during eating and 65% during following a spiral pattern.

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Graphical abstract Design of a noninvasive and smart hand tremor attenuation system: a simulation study

     

Development of a new system for evaluating the biocompatibility of implant materials using an osteogenic cell line (MC3T3-E1)

A new culture system was developed to clarify the biocompatibility of implant materials with bone tissue using the MC3T3-E1 osteogenic cell line. The cells were inoculated onto specimens such as aluminium oxide, titanium, dental casting silver-palladium alloy (PD), and a plastic coverslip. To study the effects of these materials on cell growth, differentiation, and calcification, DNA and protein content, alkaline phosphatase activity, and calcium content, respectively, were determined. The results from biochemical analysis suggest titanium and aluminum oxide to have adequate biocompatibility, while PD has an irritant effect on cell metabolism. It is clear that an objective view of the differentiation and calcification processes of osteogenic cells can be understood through such analysis. From the results of this study, our culture system appears suitable for evaluating the biocompatibility of implant materials with bone tissue.     

In vivo biocompatibility testing of peek polymer for a spinal implant system: a study in rabbits

We are developing a new spinal implant system (SIS) without fusion (bone graft). This SIS is made from two materials, metal and polyetheretherketone (PEEK) polymer. The Food and Drug Administration recommended testing in vivo, in an animal model, whether the PEEK polymer could be used in a SIS without any harm of wear debris to the nervous tissue (spinal cord and nerve roots). The objective was to evaluate the biological response of the spinal cord and nerve roots (dura mater) to PEEK polymer particles. Twenty-four female New Zealand white rabbits were used. The rabbits were divided into three groups: test (n = 12), control (n = 9), and sham (n = 3). During the surgery, the test group received the PEEK particle injections (5 x 10(7) particles per site, lumbar and thoracic), while the control group received only the vehicle (0.9% saline solution). The sham group had the same surgical approach without injection. In each group, the rabbits were euthanized at 1, 4, and 12 weeks postsurgery. The macroscopic and semiquantitative histologic analyses of the spinal cords (dura mater) showed normal vascularization and particle adherence to the connective tissue especially at the injection sites. Neither necrosis nor swelling of the dura mater and nerve roots was observed. The PEEK polymer is harmless to the spinal cord; thus it might be used as component in the spinal implant system.     

Normal development of the middle ear in the mouse: a light microscopic study of serial sections

Development of the ear, especially the middle ear, was studied histologically in ddN and CF mice. Primordia of the 3 ossicles and the otic capsule appeared on day 12 of pregnancy. The stapedial primordium was observed as a mass of mesenchymal cells lateral to the primordium of the otic capsule, attaching to the medial part of the facial nerve. On day 13, the stapedial primordium continued to develop with the Reichert's cartilage. On day 14, the malleus and incus were differentiated. On day 15, the 3 ossicles were mostly completed in shape, and the stapedial footplate had a bilaminar structure at this stage. This structure appeared to correspond to the lamina stapedialis in the developing human stapes.     

Carcinoid tumor of the middle ear. An immunohistochemical and electron microscopic study. Report of a case

A primary tumor of the middle ear was examined histologically, histochemically, immunohistochemically and ultrastructurally. Neuroendocrine cell differentiation, a carcinoid feature, was demonstrated by the presence of numerous argyrophil granules, as well as positive serotonin, glicentin, glucagon, and human pancreatic polypeptide (hPP) granules in some of the Grimelium-positive cells. Chromogranin A was also detected in the cells, but much less frequently than Grimelius-positive staining. Neither neuron-specific enolase (NSE) nor epithelial membrane antigen (EMA) was demonstrated in the tumor. Mucin was demonstrated only intraluminally. Electron microscopy revealed many typical neurosecretory granules in tumor cells, but no apical mucin granules. The tumor appeared to be benign, and there has been no sign of recurrence during a postoperative period of one year.