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Objectives/Hypothesis Current three-dimensional (3D) printed simulations are complicated by insufficient void spaces and inconsistent density. We describe a novel simulation with focus on internal anatomic fidelity and evaluate against template/identical cadaveric education. Study Design Research ethics board-approved prospective cohort study. Methods Generation of a 3D printed temporal bone was performed using a proprietary algorithm that deconstructs the digital model into slices prior to printing. This supplemental process facilitates removal of residual material from air-containing spaces and permits requisite infiltrative access to the all regions of the model. Ten otolaryngology trainees dissected a cadaveric temporal bone (CTB) followed by a matched/isomorphic 3D printed bone model (PBM), based on derivative micro-computed tomography data. Participants rated 1) physical characteristics, 2) specific anatomic constructs, 3) usefulness in skill development, and 4) perceived educational value. The survey instrument employed a seven-point Likert scale. Results Trainees felt physical characteristics of the PBM were quite similar to CTB, with highly ranked cortical (5.5 ± 1.5) and trabecular (5.2 ± 1.3) bone drill quality. The overall model was considered comparable to CTB (5.9 ± 0.74), with respectable air cell reproduction (6.1 ± 1.1). Internal constructs were rated as satisfactory (range, 4.9–6.2). The simulation was considered a beneficial training tool for all types of mastoidectomy (range, 5.9–6.6), posterior tympanotomy (6.5 ± 0.71), and skull base approaches (range, 6–6.5). Participants believed the model to be an effective training instrument (6.7 ± 0.68), which should be incorporated into the temporal bone lab (7.0 ± 0.0). The PBM was thought to improve confidence (6.7 ± 0.68) and operative performance (6.7 ± 0.48). Conclusions Study participants found the PBM to be an effective platform that compared favorably to CTB. The model was considered a valuable adjunctive training tool with both realistic mechanical and visual character. Level of Evidence NA Laryngoscope, 125:2353–2357, 2015

Objectives: The role of tympanostomy in the treatment of otitis media with effusion (OME) in children with palate cleft with regard to the otologic and audiologic outcome is controversial. Little is known about the development of the mastoid air cell system (MACS) in these children. Study Design: Controlled, prospective. Methods: All children born in the hospital district area of the Central Hospital of Central Finland during the years 1983 to 1993 with palate cleft were reviewed at the age of 6 months. A total of 39 patients were followed up for 6 years after primary tympanostomy. Otologic and audiologic data were collected, and the MACS size was planimetrically measured. The control group consisted of age-matched children without palate cleft suffering from OME and were identically reviewed. Results: The otologic outcome was similar in the study group, 64.1%, and among the controls, 60.6% were healed. There were no serious otologic complications in the study group. The audiologic outcome was also similar, with a mean pure-tone average (0.5–2 kHz) of 10.5 dB and 10.9 dB for the corresponding groups. The initial size and growth of the MACS did not significantly differ between the groups. Conclusions: The prognosis of children with palate cleft treated with early tympanostomy is favorable and does not differ from children without palate cleft. Active treatment ensures normal hearing during the critical years of language, speech, and cognitive development and maintains the development of an aerated mastoid. We believe that early tympanostomy is the treatment of choice of OME in palate cleft children.

Objectives: The objectives of this study were to examine the effect of acute otitis media on the bony development of the growing middle ear air cell system with a reliable and concise stereologic histomorphometric method and to generate a standard baseline growth plot for the middle ear of the rat. Study Design: The authors conducted a histomorphometric analysis of bullar volume during the entire growth period after early induction of unilateral otitis media. Methods: The authors conducted undecalcified processing of 27 rat skulls sectioned horizontally at various ages from 20 to 83 days after unilateral transtympanic injection of Streptococcus pneumoniae at 19 days postpartum. Stereologic estimation of bullar volume was performed in the experimental and the control ear with Cavalieri's principle. Body mass and air cell volume were plotted as functions of subject age using standard developmental equations on the experimental results. Results: Volumes of the middle ear air cell system were consistently smaller in the otitis ears. Bullar growth was completed at 60 days regardless of otitis history, but body mass was increasing throughout the experimental period. Conclusions: A single incident of otitis media introduced early in life is sufficient to significantly reduce the final volume of the bulla in rats. This finding may mimic the effect of otitis media contracted in early childhood on the development of the mastoid air cells. The standard growth plot provides a timeframe for studies of signaling molecules responsible for bone modeling in pneumatization.

E-mail: david_kieff@vmed.org Introduction/Background: There are various surgical techniques designed to treat conchae bullosae (CB). These include partial or total resection, as well as crushing. Frontal sinus balloon sinuplasty is thought to work by the crushing/remodeling of the agger nasi and frontal recess air cells. The long term of sinuplasty in the frontal/ethmoid air cell region is unknown. To date, no study has been done on the reformation of CB after crushing. We report on the long-term outcome of a series of patients who underwent crushing of their CB and suggest implications for frontal sinus balloon sinuplasty.

Fifty-five extensive mastoid cholesteatomas filling all the air cell system were found in our material of 2,192 operated-on chronic ears. They concentrated in younger age groups than ordinary cholesteatomas, although they could also be seen in older people. In the group, 95% of them had attic or posterosuperior perforation. In one-fourth of the cases the tympanum was also epidermized. The main bacteria were Proteus strains, Staphylococcus aureus/epidermidis, E. coli and Pseudomonas aeruginosa. Preoperatively, cholesteatoma could always be diagnosed but its mastoid type could be predicted only in a minority (13%) of cases. Roentgenology proved an unreliable means for revealing cholesteatoma. The extent of the mastoid air cell system varied from extensive to small depending only on the patient's age, with a correlation of smaller size to higher age. Of the ears studied, 16% were complicated and all belonged to the adult group. The growth characteristics of these extensive cholesteatomas are basically the same as in other cholesteatomas, the only difference being that, due to especially favorable environmental conditions at present unknown, the epidermosis takes the form of a more aggressive and active spreading in soft connective tissue. The effect on bone is lytic and relatively slow, passive. The operation, which must aim at the complete eradication of the cho-lesteatomatous process, did not essentially improve the hearing. On the other hand, only two ears drained postoperatively and only one had to be reoperated on, revealing residual cholesteatoma tympanally. Thus, this material with most difficult and dangerous middle ear cleft pathology, gave conclusive proof that the obliterative operation technique was safe and appropriate regardless of the quality and extent of the process.

The influence of the Mastoid Air Cell System in Chronic Otitis Media is subject to much speculation. Does a mastoidectomy influence the surgical results following chronic inflammatory ear surgery? An understanding of the pathology associated within the mastoid air cell system is necessary before a discussion of the need for a mastoidectomy can be presented. Most mastoid air cell systems are sclerotic in chronic otitis media patients. The report summarizes one author's experiences with the influence of mastoidectomy upon surgical reconstruction for chronic inflammatory diseases of the ear. Emphasis is directed toward the eustachian tube rather than the mastoid air cell system.

The mastoid air cell system probably functions as an air reservoir. Among adults with chronic otitis media a small mastoid air cell system is prevalent In cases of chronic non-purulent middle ear effusion among children, the reports have been contradictory concerning the size of the mastoid air cell system. In the present investigation, white children with long-standing problems of middle ear effusion have been examined by means of X-rays of the mastoid process in the lateral projection and the size of the air cell system measured by planimetry. The size of the air cell system was found to be significantly smaller in comparison with normal white children.