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Objective: In tympanoplasty, surgical reconstruction of the tympanic membrane and ossicular chain is well-established; however, its hearing results still require improvement. Custom 3D printing of individualized ossicular prostheses seems to be an attractive solution for optimal prosthesis adjustment and better hearing results. Aim: The aim was to design a custom ossicular prosthesis using a 3D printing method based on Cone-beam Computed Tomography (CBCT) scans and assess the acoustic conduction properties of such prosthesis. Material and methods: A cadaver fresh frozen temporal bone was used. Based on CBCT images, a new incus prosthesis was designed and 3D printed. Next, canal wall-up tympanoplasty was performed. The intact ossicular chain and reconstructed 3D-printed prosthesis chain movements/vibrations were measured with Laser Doppler Vibrometer (LDV) system and analyzed in detail. Results: The CBCT scans provided enough information about the anatomical structures. For frequencies 500 and 1000 Hz and 80 dB SPL sound intensity, collected velocities were higher for the intact ossicular chain than the 3D-printed ossicular prosthesis. The intensity thresholds for movement at 500 and 1000 Hz were lower in the intact ossicular chain than in the 3D-printed ossicular prosthesis. At 2000 Hz, there was the same intensity threshold value in the two measured circumstances. Conclusion: It is possible to design a custom individually fitted ossicular prosthesis using a 3D printing method based on CBCT scans. The acoustic conduction properties of such 3D-printed prosthesis showed differences in movability pattern between the intact and reconstructed ossicular chain. More data are needed to analyze the acoustic properties of such designed prostheses in detail. The results of our experiment showed the 3D-printed prosthesis presents the potential to be an interesting option for conductive hearing loss treatment caused by chronic otitis media and the ossicular chain defects.

Mucormycosis is a rare disease caused by fungi of the genus Mucorales . It is most common in patients with inadequately controlled diabetes mellitus, in transplant recipients or in patients with cancer. A 41-year-old patient was referred to the ENT Department of Medical University of Warsaw with a diagnosis of sinusitis and blindness of the left eye. In an interview swelling tissue of the left orbital cavity, ptosis and loss of vision in the left eye was reported. Clinical CT and MRI revealed swelling of the left half of the face and left orbital fat tissue, massive mucosal thickening in the maxillary sinus and the sphenoid sinus on the left side, encephalitis of the left frontal lobe base, poor contrast enhancement in left cavernous sinus, and hard palate ulceration on the left side. After histopathological confirmation of fungal infection of the paranasal sinuses, the patient underwent endoscopic sphenoethmoidectomy with opening of the left orbit, limited maxillectomy. The patient was treated conservatively with liposomal form of amphotericin B. Two weeks after surgery, MRI revealed an abscess of the left frontal lobe base and the base of the skull. Sinus surgery with skull base and hard palate reconstruction and also left-sided enucleation was performed. Conservative treatment was continued which resulted in an improvement. Surgery is an independent factor for improving survival in patients with invasive fungal rhinosinusitis. Important factors for the patients’ survival are spread of the disease to the central nervous system and diabetes, which can cause a double increase in mortality.

Introduction Intraoperative use of endoscopy in the treatment of chronic otitis media is one of the trends in otology. The aim of this study was to evaluate the use of the endoscope as an additional tool during canal wall up tympanoplasty with posterior tympanotomy ( endoscopy - assisted tympanoplasty) . Material and methods The study included eighty patients with chronic otitis media, the average age being 42.8 (+/-17.9) years. Intraoperative recordings endoscopic and microscopic camera were collected and visibility of anterior recess of epitympanum, sinus tympani, Eustachian tube, myryngo- and ossiculoplasty were compared on a visual analogue scale. The average value of air bone gap preoperative was compared to postoperative in main frequencies and statistical analysis by Wilcoxon test was performed. Results Optic of microscope allowed the partial visualization of anterior recess of epitympanum in 68% of the ears, while the endoscope allowed in 68% for total control of attic. Sinus tympani was completely visible in 64% of the ears in endoscopic optics, while it was not available for visual inspection in 80% of the ears in microscopic optic. Visibility of the Eustachian tube was poor in 78% of the ears in microscope, while in the endoscopic optics accurate insight into the Eustachian tube was achieved in 58% of the evaluable ears. An endoscope provided the total visibility of the tympanic membrane graft in 90% of the ears, while the microscope in 64% of the cases allowed only poor control of myryngoplasty. The endoscope has enabled the total evaluation of ossiculoplasty in 56% of the cases, and in further 24% of control was assessed on 4 points on 5-point scale, while the optics of microscope allowed to be exposed to 2 points in the adopted scale in 82% of ears. Average air bone gap postoperative statistically significant decreased in comparison to preoperative value (p = 0.0277). Conclusions Additional use of the endoscope through posterior tympanotomy during canal wall up tympanoplasty allows for much better visualization of recesses of the tympanic cavity and reconstruction of the conduction system of the middle ear.