Mastoid pneumatization and otosderosis-is there a correlation

The environment versus the genetic influence on the size of the mastoid pneumatization has been debated for years. A concrete evidence of the influence of environmental factors (e.g. inflammation) or heredity on pneumatization is still lacking. In this study the extent to mastoid peumatization in thirty otosclerotic ears was compared with control ears. The size of mastoid pneumatization was measured by the use of Law lateral x-ray projection with the help of planimetry. It was found that the average pneumatized area in otosclerotic ears was 14.73+ -3.55 cm2 compared to 10.60+3.62 cm2 in control ears which was statistically significant. In addition the mean area of mastoid air system was found to be more in the operated ears compared to the contralateral ears, the difference being statistically significant. However there was no correlation of mastoid pneumatization with degree and duration of hearing loss and type of otosclerotic focus. Our findings therefore show a link between otosclerosis and highly pneumatized mastoids thus indicating a likelihood of heredity playing a role in determining final type ot pneumatization.     

Otitis Media with Effusion in Children and Its Correlation with Foreign Body in the External Auditory Canal

Otitis Media with Effusion (OME) is difined as the chronic accumulation of mucus within the middle ear and sometimes the mastoid air cell system. Significant hearing loss may go unnoticed and may result in improper development of speech and language. Foreign bodies in the external auditory canal of paediatric patients are commonly encountered in day-to-day practice. The purpose was to see if there is any relation between foreign bodies in ears and otitis media with effusion. A prospective study of consecutive cases was conducted between August 2005 and August 2007 at a teaching hospital. All children presenting with the history of a foreign body in the external auditory canal were included in this study. 50/74 that is 67.8% of the children in the study group had abnormal findings in the tympanogram whereas only 28/74 that is 37.8% children from the control group had abnormal findings in tympanogram. This study indicates that significant eustachian tube dysfunction to frank OME, causes irritation and/or earache in children which may compel them to put things into the ear. So children with an external auditory foreign body must be followed up in an ENT clinic. This may be an early opportunity to diagnose an underlying undetected OME and/or eustachian tube dysfunction in children, preventing the development of any complication from the undetected OME.     

A Comparative Study of Eustachian Tube Functions in Normal and Diseased Ears with Tympanometry and Videonasopharyngoscopy

Eustachian tube is a bony and fibrocartilagenous tube extending from the antero-inferior part of middle ear cleft to lateral wall of the nasopharynx. Its main functions are ventilation of middle ear to equalize the middle ear pressure with atmospheric pressure and mucociliary clearance. The functioning of eustachian tube has a direct impact on normal middle ear function. As a corollary, dysfunction of eustachian tube inevitably leads to retraction of the tympanic membrane initially and sterile effusion and subsequent conductive deafness later. Secretory otitis media today is the most common cause of conductive deafness in children with an intact ear drum. Evaluation of function of eustachian tube assumes paramount importance in this scenario. To evaluate eustachian tube functions in normal and diseased ears with tympanometry and videonasopharyngoscopy and to compare the tympanometric tests of eustachian tube function with videonasopharyngoscopy and to assess their reliability. The study was conducted at Army hospital (R&R) Delhi Cantt from October 2005 to April 2007. Hundred (100) ears were examined and were divided into two groups, the control group with normal tympanic membrane on otoscopy and case group with complaints of diminished hearing and intact but retracted tympanic membrane. Their eustachian tube function was evaluated by tympanometric tests and videonasopharyngoscopy. Thereafter a comparison was made between the two. The study revealed that videonasopharyngoscopy was highly accurate and reliable test for eustachian tube function as compared to tympanometry. Slow motion video analysis of eustachian tube dynamics is a useful tool for further understanding the pathophysiology of tubal dysfunction.     

Oral submucous fibrosis with its possible effect on eustachian tube functions: A tympanometric study

Oral submucous fibrosis (OSMF) is a chronic inflammatory condition of oral cavity The common sites of involvement are cheek, tongue and soft palate The pathological changes not only involve the mucosa and submucosa but also extend deeper to involve the underlying muscles Atrophic and degenerative changes in the tubal and paratubal muscles have already been reported and involvement of these muscles may lead to eustachian tube dysfunction The present study was therefore, planned to assess the eustachian tube functions by tympanometry in cases of OSMF Out of 106 ears in 53 cases, 80 ears (75 5%) showed normal type-A curve Abnormal tympanograms included type-B curve in 17 (16 0%) and type-C curve in 9 (8 5%) ears On testing the compliance of middle ear there was shift in the compliance peaks in 78 (73 6%) ears with +200 daPa pressure change indicating normal eustachian tube functions In 28 (26 4%) ears, eustachian tube functions were found to be affected as there was no shift in the compliance peaks Similarly on-200 daPA pressure change in 24 (22 7%) ears there was no shift in compliance peaks An identical study was also carried out in 40 ears of 20 normal individuals The data derived were statistically much higher in the disease group Therefore, it was concluded that eustachian tube functions may be affected in OSMF     

Inflation-deflation test as a predictor of aditus patency in patients with chronic suppurative otitis media

Aims

To assess eustachian tubal function (ETF) preoperatively in patients with chronic suppurative otitis media (CSOM) with central perforation by performing the inflation-deflation test. To correlate the results of the inflation-deflation test with the finding of aditus patency or block in patients with CSOM

Study design

Prospective, cohort

Setting

Tertiary care hospital

Subjects

Eighty adult patients with chronic suppurative otitis media and central perforation were recruited into the study. There were 45 males and 35 females.

Methods

All patients underwent preoperative inflation-deflation test followed by cortical mastoidectomy and tympanoplasty. The patency of the aditus was assessed intraoperatively.

Main outcome measure

Equalization of pressure on inflation-deflation test and intraoperative assessment of aditus patency

Results

Of a total of 80 patients, 49 patients were found to have discharging ears and 31 had dry ears at the time of surgery. In dry ears the inflation-deflation test had a sensitivity of 93% in predicting aditus patency although the specificity was lower at 67%. In discharging ears the sensitivity in predicting aditus patency was 72% and the specificity was 67%.

Conclusion

The eustachian tube inflation-deflation test is a sensitive test for predicting aditus patency in patients with dry ears but less so in patients with discharging ears. Hence, it could be used in the former to avoid unnecessary exploration of the mastoid.     

Eustachian tube function test: a new dimension in the management of CSOM

Poor eustachian tube function is a major cause of both failure of tympanoplasty as well as the persistence of otorrhoea in chronic suppurative otiis media. In this study, Eustachian tube function tests were carried out on 631 ears of CSOM using an impedance audiometer and the results were analysed. The study showed that impaired tubal function is not only the major cause of persistent/recurrent otorrhoea in CSOM but is also an important contributory factor for failure of tympanoplasty: The results of tympanoplasty were found to be significantly poor when carried out in ears having poor tubal function as compared to ears with normal tubal function.     

Retraction pockets in the tympanic membrane — aetiology and management — our view point

Retraction pockets of the tympanic membrane are believed to be due to eustachian tube obstruction or malfunction. Our observations based on intraoperative findings suggest that the presence of a large sized mastoid antrum along with chronic eustachian tube obstruction plays an important role in the causation of retraction pockets. Granular myringitis may also occur in these circumstances when there is a recurrent eustachian tube blockage due to infection especially if the patient has received frequent and inadequate courses of antibiotics. The use of chromic catgut to create a healed air-filled middle ear space along with a canal wall down tympanomastoidectomy is discussed for their effective treatment.     

鼻咽癌3-D计划放射治疗后放射性中耳炎的临床分析

背景与目的:中耳咽鼓管损害高峰发生在放疗后半年,并且在很多病例可持续终身,至今为止临床上尚无有效的治疗方法,寻求放射治疗中中耳鼓室及咽鼓管更好的保护仍是放射治疗医师面临的责任,在精确放疗技术应用逐渐普遍的今天,肿瘤周围正常组织和器官的保护受到越来越多的重视,但到目前为止,有关中耳放射损伤的研究报道极少。我们采用回顾性分析的方法,通过比较鼓室腔及骨性段咽鼓管剂量分布与放疗后分泌性中耳炎的发生率,评价在鼻咽癌3-D计划放射治疗中中耳功能保护的可能性,同时了解放疗后时间、化疗、T分期等因素对结果的影响。方法:40例80耳有完整听力学检查材料的鼻咽癌3-D计划放射治疗的患者进入此项研究。所有病例放疗前后均经耳部检查,电测听及声阻抗测听,放疗后随访时间为6~24个月。电测听以500,1 000,2 000,4 000 Hz听阈平均值计算气骨导差,声阻抗根据鼓室图分为A、B、C 3型,A型为正常鼓室图,B型为中耳鼓室积液,C型为咽鼓管功能不良。结果:79耳符合声阻抗分析条件。放疗后62%耳与放疗前保持不变,13%耳得到改善,25%耳恶化。鼓室腔及骨性段咽鼓管剂量分布在恶化耳与其他各组耳之间比较差异有显著性。80耳电测听分析结果,放疗后无变化耳58%,改善耳12%,恶化耳30%。分析剂量因素对声阻抗结果的影响,恶化组的鼓室腔及骨性段咽鼓管平均受照剂量为(5379.81±706.01)cGy,不变组的平均受照剂量为(4735.72±812.30)cGy,改善组的平均剂量为(4652.86±809.78)cGy;分析剂量因素对电测听结果的影响,恶化组的中耳及骨性咽鼓管平均受量为(5229.38±778.11)cGy,不变组的平均受量为(4719.64±744.82)cGy,改善组的平均剂量为(4702.38±922.21)cGy。统计分析发现3组的剂量差异有显著性。T分期变化及1年内或1年后时间分组对听力测试结果的影响差异有显著性,而化疗对听力测试结果的影响不明显。结论:在鼻咽癌3-D放射治疗中,如将鼓室腔及骨性段咽鼓管剂量控制在4700 cGy以下,则可明显减少延迟性放射性中耳炎的发生率。对中耳鼓室腔及骨性段的保护随着肿瘤体积的增大可能性减少。放射性中耳功能损伤发病高峰在1年内,在放疗前具有正常听觉功能者,放疗1年后有更多的机会从放射损伤中恢复。     

鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值

背景与目的:对于放疗后咽鼓管功能已经严重受损的分泌性中耳炎,目前的治疗方法疗效有限。鼓膜穿孔可以避免分泌性中耳炎的复发,本研究旨在探讨鼓膜部分切除术治疗鼻咽癌放疗后分泌性中耳炎的临床价值。方法:经过综合的耳功能检测,确认鼻咽癌放疗后分泌性中耳炎患耳的咽鼓管功能已经严重受损后,对16例(18耳)符合条件的患者施行鼓膜部分切除术,对术后患者的听力及其它症状进行超过6个月的随访观察。结果:鼓膜部分切除术后61%(11/18)残留鼓膜穿孔,患者听力普遍提高,平均气骨导差由术前的30.1dB减至16.0dB,耳闷、耳鸣和头痛等症状基本消失。鼓膜部分切除术后鼓膜再愈合7耳(39%),术前和术后平均气骨导差分别是33.0dB和32.1dB。结论:鼓膜部分切除术治疗分泌性中耳炎疗效确切而持久,对鼓膜再愈合耳的听功能无损害。     

Effectiveness of Intratympanic Dexamethasone in Otitis Media with Effusion Resistant to Conventional Therapy

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air–bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air–bone gap, 3 dB AC–PTA and 1.36 dB BC–PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.     

Tympanometric study on the effect of nasal packing on eustachian tube function

Tympanometric study on 50 cases (100 ears), requiring anterior and posterior nasal packing, was conducted to evaluate the eustachian tube dysfunction as a middle ear pressure variation subsequent to these nasal packings. This study favours the clinical observation that nasal packing may result in eustachian tube dysfunction. Combined posterior and anterior nasal packing is associated with a substantially greater incidence of dysfunction than anterior nasal packing alone and this phenomenon is reversible.     

Bilateral Type 1 Tympanoplasty in Chronic Otitis Media

A theoretical risk of iatrogenic sensorineural hearing loss during surgery has induced a reluctance to perform bilateral tympanoplasty type I among some otosurgeons. This paper presents results of bilateral surgery in 14 patients (28 ears). Fourteen patients with bilateral, dry tympanic membrane perforations caused by chronic otitis media were selected prospectively for bilateral tympanoplasty type I (28 ears) at a tertiary referral center. All patients had a HL corresponding to the size and localization of the perforation (no suspicion of ossicular chain defect or other pathology). Mean age was 37.5 years. There were seven males and seven females in our study. All but five ears were operated through an endaural or endomeatal approach, and five ears operated by postaural approach. The Underlay technique was used in all cases. Total ten cases operated using Fascia Lata and four cases operated using Temporalis fascia as graft material. Follow-up examination and hearing tests (pure tone audiometry) were performed up to 20 months after surgery. The graft take rate was 96%, with no retraction pockets or displaced grafts observed during follow-up. One patient had small residual perforation which healed at the end of 3 months. Hearing improved significantly, and the air-bone gap was significantly reduced. The air-bone gap was closed to within 10 dB in 92% and within 20 dB in 100% of the ears. Surprisingly good hearing was found during postoperative, bilateral ear canal gauze packing. Iatrogenic sensorineural HL did not occur. We conclude that bilateral myringoplasty is safe, with good results, reduces costs, and leaves the patient satisfied. The hearing impairment during postoperative ear canal packing is surprisingly modest and readily acceptable by the patients.     

Efficacy of various methods in evaluation of eustachian tube function

In the present study 35 patients with preforated and 15 cases with intact ear drums, were studied and eustachian tube function was assessed by Saccharine test. Bortnick-Miller test, and manual impedance audiometry. The merits and demerits of one over the other were evaluated. It was observed thal more than one test when employed provides better information as every test has its own advantages and limitations     

Retraction pockets in chronic suppurative otitis media- our experience

Retractions of the tympanic membrane constitute a large proportion of ear diseases causing concern to the otologist. The clinical features in a case of retraction pocket are varied and cholesteatoma. Also, that a retraction pocket in the posterosuperior region and pars ftaccida is a precursor of cholesteatoma is now well recognized. We have studied 60 cases of retraction pockets during a period of 5 years and have attempted to find out the etiology as well as the most effective treatment in such cases. Though over the years along with a dysfunctional eustachian tube, a sclerotic mastoid has been implicated as one of the causes of Retraction Pockets, we in our study have seen a large sized mastoid antrum (beyond 2 mm vf Lateral Semicircular Canal) as a consistent feature in most of our cases. This was subjectively assessed as a surgical finding in tympanomastoidectomy and objectively assessed by a high Resolution Computed Tomography of the temporal bone. We have found that a canal wall down mastoidectomy was the most effective in preventing the recurrence of retraction pockets. In a coutry like India, canal wall down mastoidectomy offers an acceptable solution to the problem of retraction pocket as not only is the follow up of patients poor but also the “Second- Look” procedure is not always possible. The use of 1- 0 chromic catgut in the middle ear instead of the more conventionally used silastic in preventing recurrent retractions can be considered as an effective single-staged procedure.     

Study of corelation between eustachian tube functions and result of myringoplasty

In the present study of 34 cases of dry central perforations, 26 cases of adhesive otitis media and 2 cases of adhesive otitis media with postero superior inpouching, the eustachian tube function was assessed pre-operatively in a qualitative & quantitative manner to evaluate there dependability in predicting the outcome of Myringoplasty. Amongst other tests valsalva & forced response tests gave the most reliable results.     

Assessment of eustachian tube functions in patients with ear drum perforation

Tubal malfunction is the most important factor in the development and persistence of otitis media. When the eustachian tube malfunction persists, the most carefully performed surgery will fail because the initiating pathogenetic factors of eustachian tube function and middle ear ventilation are still present. Measurement of the eustachian tube function is therefore an important part of the medical and surgical evaluation of the middle ear disease.     

Comparative Study of Outcome of Endoscopic Myringoplasty in Active and Inactive Mucosal Chronic Otitis Media Patients

The objective of this study was to compare graft uptake and hearing improvement in active and inactive mucosal chronic otitis media patients after endoscopic myringoplasty. This is prospective study conducted at a government medical college and hospital from February 2014 to August 2015. A total of 40 active (wet) ears with mucoid discharge and 40 inactive (dry) ears (at least 6 weeks dry before surgery) with mucosal chronic otitis media were operated on by endoscopic myringoplasty by transcanal approach. Graft uptake and hearing gain rates 3 months after surgery were compared for both groups. Endoscopic myringoplasty using temporal fascia graft via transcanal approach was used. The graft take rate was 77.5% for the active ear group and 85% for the inactive ear group. The hearing gain rate was 82.5% for the inactive ear group and 72.5% for the active ear group. Differences were found to be statistically insignificant for both graft uptake and hearing gain. The success of endoscopic myringoplasty is not adversely affected by the presence of mucoid ear discharge at the time of surgery, and outcomes are comparable to those of the operation done for inactive ear.     

Pneumatization Pattern in Squamousal Type of Chronic Otitis Media

To study the pneumatization pattern of mastoid bone in cases of squamousal type of chronic otits media and analyze pneumatization pattern of opposite normal ear in cases of unilateral chronic otitis media (COM). A total of 94 patients (104 ears) between the age group of 7–84 years attending the E.N.T outpatients, inpatients and casualty of Acharya Vinoba Bhave Rural Hospital, Sawangi (Maghe), Wardha, after applying inclusion and exclusion criteria were found suitable and hence selected for the present study and were subjected to bilateral X-ray mastoid (Schuller’s view). HRCT temporal bone done in selected 55 patients. On analyzing patients radiologically (X-ray mastoid), it was found that out 104 ears, mastoid was pneumatized in 2 (1.92 %) diploic in 20 (19.23 %) and sclerotic in 82 (78.85 %) ears. Contralateral mastoid of 70 normal ears, mastoid was pneumatized in 30 (42.86 %) diploic in 22 (31.43 %) and sclerotic in 18 (25.71 %) ears. Most of the diseased ear demonstrated non pneumatized mastoid (98.08 %) whereas contra lateral mastoid of 70 normal ear, showed significantly more pneumatization This difference is statistically significant (P value < 0.0001). Significantly more sclerosis and non pneumatization in the ear with COM of squamousal type than the healthy contralateral ear supports the environmental theory.     

The Bortnick Miller apparatus: a useful alternative to impedance audiometer for assessment of eustachian tube function in chronic suppurative otitis media

Eustachian tube function was assessed by impedance audiometer and Bortnick Miller apparatus in 60 ears with central perforation in pars tensa. Result of both the instruments were compared and presented.     

Eustachian tube function after transmyringeal ventilation

This study anus at determining the effect of transmyringeal ventilation on Eustachian tube functions. Seventy ears clinically diagnosed as having otitis media with effusion or grade I and II retraction of pars-tensa of tympanic membrane were treated with antiallergics, decongestants, mucolytics, and antibiotics as required for maximum upto three months. In forty-five ears that showed neither symptomatic nor audiometric improvement, transmyringeal ventilation was restored by myringotomy and ventilation tube insertion. There after, Eustachian tube functions were assessed by using pressure equilibration test. The post-operative audiograms showed mean hearing gain of 16. 6 dB (S D±7.9) in majority (96%) of the ears. At first week 93% ears could not either totally or partially equilibrate positive or negative pressure. The percentage in the poor function group remained 91% even at the end of 6 months showing no significant effect of ventilation tube insertion on active ET functions.