中耳结构动力响应对不同病理圆窗封闭的反馈

目的研究耳蜗圆窗病变对中耳结构力学行为的影响。方法依据临床健康志愿者右耳CT扫描结果,将CT扫描数据数值化导入PATRAN软件进行人耳三维有限元模型重建,并应用NASTRAN软件进行流固耦合频率响应分析,通过数值模拟方法探讨中耳结构动力响应对内耳耳蜗圆窗病变的反馈。结果硬化症导致的圆窗封闭比先天性圆窗封闭使镫骨振幅下降更多,最大达到30. 2 d B,且后者不会对镫骨振动速度产生明显影响。相位角方面,硬化症情况下镫骨和圆窗均最多产生90°变化,且两者保持180°差值;而先天性圆窗封闭情况下镫骨最大有270°变化,同时圆窗相位角变化消失。结论基于振幅、速度和相位角,镫骨动力行为会对先天性和硬化症导致的圆窗封闭形成不同的反馈表现,研究结果可为未来临床上诊断及修复圆窗病变提供理论支撑。     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

耳内镜下新西兰兔中耳的解剖研究

目的　耳内镜下观察兔中耳解剖结构,探讨兔作为耳内镜解剖训练模型的可行性,为兔中耳相关的其他实验研究提供解剖学依据。 方法　5只（10耳）新西兰兔麻醉处死后,耳内镜下经外耳道入路观察兔鼓膜、中耳鼓室结构,辨别听小骨、上中下鼓室、面神经等。 结果　与人对比,新西兰兔听小骨由锤砧联合体和镫骨组成;上鼓室外侧壁部分骨质缺如,由鼓膜向上延续并覆盖;听泡类似于人的中、下鼓室,包含咽鼓管、面神经、鼓岬、前庭窗、蜗窗以及鼓室神经等结构,乳突为听泡尾侧的板障型骨管;面神经鼓室段水平走行于上鼓室下方骨壁内,后经锥隆起垂直走行于听泡后壁,经茎乳孔出听泡。 结论　新西兰兔中耳结构与人相似,既可作为耳科医生练习耳内镜操作的解剖模型,也可作为耳部三维解剖结构的教学标本。     

早产儿黄疸与听力损伤关系的研究

目的探讨不同水平胆红素对不同胎龄、不同日龄及不同出生体重的早产儿听力损伤的影响,以及影响早产儿听力的其他高危因素。方法对227例早产儿住院期间胆红素水平、听力损伤情况及其他高危因素进行研究分析。结果227例早产儿中,根据不同胎龄、不同日龄、不同出生体重、不同胆红素水平进行分类,其中轻度黄疸73例,中度黄疸127例,重度黄疸27例,生后4-7d首次畸变产物耳声发射检查正常147例,异常80例,3月时复查脑干听觉诱发电位150例,结合随访结果诊断听力障碍10例。结论黄疸是导致早产儿听力损伤的主要原因之一,不同水平胆红素对不同胎龄、不同日龄、不同出生体重的早产儿听力损伤作用不同。同一胆红素水平对胎龄越小,日龄越小,出生体重越低的早产儿听力损伤越大。而胎龄、日龄、出生体重相同时,则胆红素水平与听力损伤呈正相关。早产儿听力损伤受多种因素的影响,常随早产儿其他神经系统的发育而逐渐恢复。     

显示中耳和内耳细微结构的标准化标本制作方法

目的 探索显示中耳和内耳细微结构直视标本的标准化制作方法。 方法 使用人颞骨材料,在颅内和颅底面画出标准锯路的标志线,选择细齿窄条钢弓锯,沿标志线锯开颞骨显示中耳结构。再用手握式玉石磨钻分别研磨显示内耳结构。最后完成对鼓膜、听小骨、面神经、鼓索神经和颈内动脉等结构的仿真复原,并用合页连结锯开的两半颞骨。 结果 在锯开的颞骨内可清晰显示中耳鼓室的6个壁,以及锥状隆起、咽鼓管、前庭窗和蜗窗等细微结构。磨制后的内耳可见3个打开的骨半规管和耳蜗的剖面。复原后的听骨链、面神经、鼓索神经、颈内动脉和鼓膜等结构,均以三维方式显示原有结构的特征和位置关系。由合页连结的颞骨标本,既可打开观察内部结构,也可合拢显示整体形态。 结论 采用锯开和研磨技术制作耳标本可以取得满意的结果,标准化的锯路标志和标准的定位研磨是成功制作的关键。     

内窥镜下中耳置管术治疗小儿分泌性中耳炎

目的 应用内窥镜技术提高对儿童分泌性中耳炎的诊断和治疗水平，恢复提高患者听力。方法对64例（114耳）儿童分泌性中耳炎在窥镜导引下行鼓膜切开置管术。结果 64例患儿随访0．5年～2年，51例（80％）听力明显改善，纯音听阈。声阻抗基本恢复正常，13例患儿听力有不同程度的提高，有效率100％。结论 内窥镜下中耳置管术具有显微镜下手术同等优点，且具有简单、易掌握等优点，对分泌性中耳炎患儿不失为一种有效的治疗方法。     

中耳病变及人工镫骨形体研究

目的 研究听骨韧带、肌腱硬化和切除以及人工镫骨置换对声音传导的影响。方法 基于CT扫描数据,通过自编C＋＋程序读取CT数据中体单元建立人耳结构几何模型,将几何模型导入PATRAN中赋予材料参数、设置关节接触面以及相应其他边界条件生成数值模型。结果 利用本文人耳数值模型进行正常耳和病变耳的谐响应分析,得到正常耳和病变耳镫骨底板和鼓膜凸的振幅变化规律。并由此构建了套型人工镫骨。结论 正常耳的模拟结果与实验测试结果吻合,证明了本模型准确性,可以模拟人传声功能。本模型模拟病变耳的计算结果可以从力学角度解释病变对声音传导的影响,为病变耳治疗提供参考。本文的套型人工镫骨较我国临床用的环型人工镫骨更吻合人耳的生理功能,其重建听力效果更好。     

门静脉内皮细胞损伤与门静脉高压症相互关系的研究

采用Masson三色染色法,辅以形态学观察,研究肝硬变病人(n=30)肝内外门静脉的内皮细胞变化。发现血管内皮细胞有明显损伤,伴血栓形成及管壁结构改建。提示血管内皮细胞损伤与门静脉高压症有密切关系。     

中耳畸形对能量吸收率影响的数值研究

为了研究中耳畸形对能量吸收率的影响,本文基于前期所建人耳有限元模型,构建了一个能够模拟人耳能量吸收的力学模型,并利用两组实验数据验证了该模型。基于该模型,通过改变相应组织的结构和材料属性,模拟了砧镫关节缺失、砧骨固定和锤骨固定、镫骨固定这三类常见的中耳畸形;对比分析这三类畸形相应的能量吸收率,研究了中耳畸形对能量吸收率的影响。结果表明:砧镫关节缺失会使能量吸收率在1000 Hz附近显著增大。砧骨固定和锤骨固定会使能量吸收率在低频阶段急剧减小,且在1000 Hz以下低于10%;与此同时,能量吸收率的峰值移向更高频率。对于这两类中耳畸形,在宽频声导抗测试中具有较为明显的特征。而镫骨固定会使能量吸收率在低频段减小、中频段增大,但变化程度较小,在宽频声导抗测试中无明显特征。本文研究结果或可为临床上中耳畸形的宽频声导抗诊断提供一些理论参考。     

高压热塑料喷射致手掌冲击伤和热损伤一例

患者男，48岁，塑料厂工人，既往健康。工作中不慎被高压喷塑枪喷出的高压热塑料液体击中左手掌内侧，喷塑枪压力约300kPa，塑料温度约140℃。患者伤后30min急诊入院治疗。入院时患者神智清楚，表情痛苦，步人病房，体检：体温36．5℃，     

Finite element analysis of the middle ear transfer functions and related pathologies

With developments in software and micro-measurement technology, a three-dimensional middle ear finite element (FE) model can now be more easily constructed to study sound transfer function. Many FE models of the middle ear have been constructed to date, and each has its own particular advantages and disadvantages. In this article, we review the latest developments and technologies in the field of the FE models of the middle ear, and the use of FE in the study of middle ear pathology. Proposals are made for future developments in the field of finite element analysis of middle ear transfer function.     

Electronic model of the middle ear

An electronic model of the human middle ear is described. It is based on the qualitative behaviour of the middle ear and includes middle-ear threshold, limiting and amplifying characteristics. The model has the capacity to reject the same range of frequencies as the middle ear. Analogy has been made between electrical quantities and acoustic quantities. The response of the model has been compared with available experimental evidence with reasonable agreement.     

Glycoconjugates in the middle ear and eustachian tubal epithelium

Glycoconjugates in the middle ear and eustachian tubal epithelium were investigated using lectin histochemical techniques. A comparison of the affinity of lectins demonstrated the heterogeneity of glycoconjugates in the secretory cells of the middle ear and eustachian tubal epithelium. Lectin histochemical analysis of sialoglycoconjugates in the developing murine tubotympanum showed that terminal galactose residues are masked by sialic acids around birth, and that sialic acids are important for mucociliary function.     

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.     

Carcinoid tumor of the middle ear: a case report and review of literature

Carcinoid tumors of the middle ear are very rare. Here we describe a 37-year-old man with multiple recurrent carcinoid tumor of the right middle ear. The CT demonstrated the recurrent mass that filled the tympanum and mastoid with osteolytic invasion, and the tumor was removed by surgery. The pathological findings showed the tumor cells, without necrosis and mitotic activity, had round, oval, or slightly irregular nuclei and finely-dispersed chromatin, arranged in cords, nests, and glandular structures. They were strongly positive for synaptophysin and CD56, but were negative for S-100 and chromogranin A. Ki-67 proliferation activity was low (<2%). With a review of the literature, the clinical, pathological characteristics and treatment modalities of this rare tumor are discussed.     

中耳显微解剖标志与面神经定位

目的 观察中耳手术中面神经相关的显微解剖结构,并探讨其临床应用。方法 30具(60侧颞骨)中国人成年湿性头颅标本经乳突入路对颞骨进行显微解剖,重点观察面神经并根据其周围的固定解剖标志对其进行定位。 结果 面神经乳突段前缘和后缘至假想定位线的距离分别为（-0.11±0.36）mm和（-0.14±0.38）mm,鼓室段面神经下缘与假想定位线的距离为（0.31±0.12）mm,砧骨短脚末端至外半规管下缘的距离为（1.73±0.24）mm,外半规管至面神经锥段上缘的距离为（2.65±0.25）mm,砧骨短脚最末端至面神经锥段上缘的距离为（2.20±0.41）mm,镫骨头上缘至面神经水平段下缘的距离为（2.24±0.23）mm等。结论 外半规管、砧骨短突、鼓环、二腹肌嵴、前庭窗、匙突、卵圆窗、锥隆起和鼓索神经等是中耳显微手术的重要解剖标志,并与面神经关系极其密切和恒定。     

Effect of anterior tympanomeatal angle blunting on the middle ear transfer function using a finite element ear model

The anterior tympanomeatal angle (ATA) blunting is clinically defined as a certain degree of the ATA obliteration due to excessive fibrous tissue formation, which is a relatively common complication of external auditory canal (EAC) related operations. The aim of this study was to examine the effect of ATA blunting on the middle ear transfer function using a finite element (FE) model. Results showed that the displacements at the tympanic membrane (TM), at the manubrium and at the stapes footplate, and also the ratio of stapes footplate velocity to the sound pressure in the EAC were decreased to various degrees from ATA blunting of Grades 1–4. This was more significant with TM thickening at the frequencies below 3.2 kHz, particularly in Grades 3 and 4 when analyzing the anterior region of the TM. The phase differences of TM and stapes footplate increased with the ATA blunting from Grades 1 to 4 in relation to normal ATA. It is noteworthy that the vibration mode of the malleus does not show obvious change, compared to the displacement reduction at the TM with ATA blunting Grades 1–4. These results suggest that FE analysis of ATA blunting effect appears to be effective.     

A morphometric study of human middle ear ossicles in cadaveric temporal bones of Indian population and a comparative analysis

Introduction

Malleus, Incus and Stapes are the three middle ear ossicles which form an articulated chain and help in conduction of sound from external ear to inner ear. Morphometric study of these ossicles has been going since the early 60s. Although the methods of been changing due to advent of newer technologies and treatments.