Search

Purpose: The purpose of this study is to determine the recurrence rate of cholesteatoma in patients who have undergone exclusive endoscopic tympanoplasty at our tertiary referral institution. A secondary objective is to analyze different clinical aspects that could be considered risk factors for recurrence to establish if it is possible to determine when a second-look procedure is indicated instead of a clinical follow-up. Methods: A retrospective study was performed on patients who had undergone exclusive endoscopic tympanoplasty for cholesteatoma in the last eight years and who were followed up for at least one year. The efficacy of the treatment performed only with the exclusive endoscopic technique was analyzed. Then, the anamnestic and intraoperative data were studied to identify possible factors that could increase the risk of recurrence. Results: The recurrence rate (14.5%) in patients (164) who underwent primary surgery with the exclusive endoscopic technique between January 2014 and January 2022 was similar to that in patients who underwent the microscopic technique with mastoidectomy in literature. In addition, we analyzed several clinical factors such as age, ossicular chain erosion, extension and localization of the cholesteatoma finding that only the last one could potentially be a risk factor for recurrence in this selected population. Conclusion: Exclusive endoscopic tympanoplasty has been shown to be effective in removing cholesteatoma in patients without evidence of mastoid involvement, with recurrence rates comparable to traditional microscopic technique and a minimally invasive approach, even considering the patient's age, ossicular chain erosion and extension of the disease. [ABSTRACT FROM AUTHOR]

ABSTRACT The chorda tympani nerve (CTN) plays a significant role in taste transmission and salivary secretion. Due to its course in the tympanic cavity and its relation to the ossicular chain, there is a high risk of iatrogenic damage to the CTN during otologic surgeries. This study aimed to assess the impact of different handling methods of the CTN during endoscopic ear surgery on patients' taste perception. A cohort study conducted from 2022 to 2023 in a tertiary hospital involved participants undergoing various types of endoscopic ear surgeries. Based on intraoperative handling of the CTN, participants were divided into three groups: intact, traction (subdivided into mild, moderate and severe traction subgroups) and transection (subdivided into transection without tension, with tension and tearing subgroups). Taste tests were administered from 1 day before surgery to 6 months postoperatively. Endoscopic ear surgery for treating ear pathologies. Taste test scores, other relevant symptoms. Significant differences were observed in the incidence and recovery time of taste dysfunction across groups. The rate of taste abnormalities and recovery time increased with the degree of traction; the severe traction and transection subgroups showed the highest rates of abnormalities and cases of incomplete recovery. In terms of disease type, patients with chronic suppurative otitis media and cholesteatoma showed significant differences in preoperative taste status, abnormality rates and recovery times compared to patients with non‐inflammatory ear diseases. General sensory abnormalities of the tongue were mainly found in moderate‐to‐severe traction subgroups and all transection groups, often accompanying taste reduction or loss. Some patients in the transection group experienced only numbness or both increased taste sensation and numbness. The study underscores the importance of delicate handling of the CTN in endoscopic ear surgery, especially in patients with inflammatory middle ear diseases. It suggests minimising severe traction injuries and considering early and accurate transection to reduce traction injuries when preservation is challenging; any manipulation of the CTN should be avoided in patients with non‐inflammatory conditions. This research provides valuable theoretical support for clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. Materials and Methods: A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Results: Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Conclusion: Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented. [ABSTRACT FROM AUTHOR]

Whereas mammals are characterized by the presence of three middle ear ossicles, reptiles have only one, the columella (stapes). Nevertheless, there is a great diversity of columellar anatomy among sauropsids, especially in the unique and cartilaginous “extracolumella”‐portion. Molecular studies revealed the “columella” of chicken and quails to be formed within the second pharyngeal arch, although conflicting evidence exists for the columellar footplate and distal parts of the columella in these birds. We studied columellar development in four turtles, one lizard, and one caiman species and argue, using early blastematous stages, that, distally, the so‐called “extracolumella” in turtles is mainly of quadrate, that is, first pharyngeal arch origin. Differently, the dorsal aspect of the “extracolumella” of the lizard and a part of the “dorsal columella process” of the caiman are likely quadrate‐derived. This indicates only a partial homology of the distal columellar compartments among reptiles. Moreover, we observed in most species that, at early stages, the footplate differentiates from the otic capsule, which confirms widespread experimental findings of mesodermal cells contributing to the proximal part of the columella. We provide a hypothetical framework for the changes in the columella and quadrate morphology in reptilian evolution. Originally, as evidenced by the fossil record, the columella served as a stabilizing brace between the quadrate and braincase. Associated with changes in the feeding mode of late Permian taxa, the quadrate was integrated along the stress flows from biting, and in early development part of the quadrate differentiated to differently contribute to the distal part of the “columella‐complex,” which now contacts the tympanic membrane. In addition, part of the original otic capsule contributes to the footplate of the mobile columella, providing a connection with the inner ear. [ABSTRACT FROM AUTHOR]

Ossicular fixation disturbs the mobility of the ossicular chain and causes conductive hearing loss. To diagnose the lesion area, otologists typically assess ossicular mobility through intraoperative palpation. Quantification of ossicular mobility and evidence-based diagnostic criteria are necessary for accurate assessment of each pathology, because diagnosis via palpation can rely on the surgeons' experiences and skills. In this study, ossicular mobilities were simulated in 92 pathological cases of ossicular fixation as compliances using a finite-element (FE) model of the human middle ear. The validity of the ossicular mobilities obtained from the FE model was verified by comparison with measurements of ossicular mobilities in cadavers using our newly developed intraoperative ossicular mobility measurement system. The fixation-induced changes in hearing were validated by comparison with changes in the stapedial velocities obtained from the FE model with measurements reported in patients and in temporal bones. The 92 cases were classified into four groups by conducting a cluster analysis based on the simulated ossicular compliances. Most importantly, the cases of combined fixation of the malleus and/or the incus with otosclerosis were classified into two different surgical procedure groups by degree of fixation, i.e., malleo-stapedotomy and stapedotomy. These results suggest that pathological characteristics can be detected using quantitatively measured ossicular compliances followed by cluster analysis, and therefore, an effective diagnosis of ossicular fixation is achievable. [ABSTRACT FROM AUTHOR]

This article presents a case report on a patient who underwent a surgical procedure to repair a pseudomeningocele and tympanoplasty. The patient had symptoms of ear discharge and hearing loss. The surgical approach involved repairing a bony defect in the tegmen tympani using septal cartilage and fascia lata. The article emphasizes the importance of surgical treatment to prevent complications and discusses different surgical approaches for repairing tegmen defects. The combined middle cranial fossa approach is highlighted as a minimally invasive procedure that preserves hearing. [Extracted from the article]

Osteogenesis imperfecta (OI) is a group of rare hereditary collagen disorders. Hearing loss (HL) is a known complication linked to changes in the bones of the middle ear seen in OI. We aimed to determine the prevalence, age at debut, incidence, and risk of HL, surgery on bones of the middle ear, and use of hearing aids. A Danish nationwide, register-based cohort study. Data were extracted from the Danish National Patient register. Anyone with an OI diagnosis between January 1st 1977 and December 31st 2018, matched 1:5 with a reference population (Ref.Pop) on birthyear and sex, were included. 864 persons (487 women) with OI were included in the study and 4276 (2330 women) in the Ref.Pop. The sub-hazard ratio (SHR) for any HL was 4.56 [95% CI 3.64–5.71], with a prevalence of 17.0% and 4.0% in the OI cohort and Ref.Pop. Median age at debut was 42 and 58 years, respectively. The risk of otosclerosis and/or surgery was higher in the OI cohort (SHR 22.51 [95% CI 12.62–40.14]), with a median age at debut of 43 and 32 years in the OI cohort and Ref.Pop, respectively. Hearing aid use was more frequent in the OI cohort (SHR 4.16 [95% CI 3.21–5.40]) than in the Ref.Pop. The median age at debut was 45 and 60 years in the OI cohort and Ref.Pop, respectively. Persons with OI have a higher risk and prevalence of HL, hearing aids, and surgery, debuting younger, and prevalence increases with age. [ABSTRACT FROM AUTHOR]

Congenital cholesteatoma (CC) is a non-neoplastic lesion of keratin debris lined by epithelium found in the temporal bone. It is the lesser-known sibling of the acquired cholesteatoma and may be classified as congenital middle ear cholesteatoma and congenital petrous bone cholesteatoma. The incidence is rising, probably owing to increased recognition and advances in imaging modalities. Cone beam CT provides detailed anatomical information, highlighting quadrant location, ossicular involvement, and mastoid extension. MRI aids in lesion characterization and detection of complications. The classification systems for congenital middle ear and petrous bone cholesteatoma are helpful in the preoperative workup and have a role in predicting postoperative recurrence rates. Management almost invariably involves surgical intervention aimed at preserving middle and inner ear function. Follow-up of CC is mainly based on MRI together with otoscopic examination. Non-echo planar diffusion-weighted imaging, especially, has proven essential for detecting residual disease. This review article emphasizes the significance of imaging in the timely diagnosis and management of CCs. Clinical relevance statement: This article underscores the crucial role of imaging for prompt detection, preoperative assessment, and postoperative follow-up of CCs, a condition with rising incidence associated with potentially severe complications. Key Points: Timely diagnosis of CCs is imperative for avoiding complications. Imaging is key in detection, preoperative evaluation, and postoperative management. Cone Beam CT and non-echo planar DWI represent state-of-the-art imaging techniques. [ABSTRACT FROM AUTHOR]

Background: Middle ear active implants, such as the Vibrant Soundbridge (VSB), offer an alternative to reconstructive surgery and other implantable hearing aid systems for patients with conductive, mixed, or sensorineural hearing loss. The primary objective of this work is to describe the auditory results obtained with VSB in our patient cohort, measuring the auditory gain in terms of average tonal thresholds and spoken word discrimination at 65 dB. Secondly, auditory gain differences between different types of hearing loss, coupling to the ossicular chain compared to round and oval windows, and the impact of open versus more conservative surgical approaches, were analyzed. Methods: A cross-sectional observational study, with retrospective data collection, was conducted at a tertiary care center. Clinical and audiometric data pre- and post-implantation were included, from patients who underwent VSB device placement surgery between 2001 and 2024. Results: 55 patients with an average age of 62.58 ± 17.83 years and a slight preference in terms of the female gender (52.72%) were included in the study. The average gain in the PTA for all types of hearing loss was 41.56 ± 22.63 dB, while for sensorineural hearing loss (SNHL) the gain was 31.04 ± 8.80 dB. For mixed-conductive hearing loss (C-MHL) a gain of 42.96 ± 17.70 was achieved, notably, in terms of absolute values, at frequencies of 4000 and 6000 Hz, with gains reaching 49.25 ± 20.26 dB at 4 K and 51.16 ± 17.48 dB at 6 K. In terms of spoken word discrimination, for all types of hearing loss, an improvement of 75.20 ± 10.11% was achieved. However, patients with C-MHL exhibited an approximately 13% higher gain compared to those with SNHL (69.32 ± 24.58% vs. 57.79 ± 15.28%). No significant differences in auditory gain were found between open and closed surgical techniques, nor in the proportion of adverse effects, when comparing one technique with the other. Conclusions: The VSB is effective in improving hearing in patients with mixed, conductive, and sensorineural hearing loss, with significant gains at high frequencies, especially through the round window membrane approach. The choice of surgical technique should consider the patient's anatomical characteristics and specific needs in order to optimize auditory outcomes and minimize postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether the quality of high-resolution computed tomography (CT) images of the temporal bone improves with deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (HIR). Methods: This retrospective study enrolled 36 patients (15 men, 21 women; age, 53.9 ± 19.5 years) who had undergone high-resolution CT of the temporal bone. Axial and coronal images were reconstructed using DLR, HIR, and filtered back projection (FBP). In qualitative image analyses, two radiologists independently compared the DLR and HIR images with FBP in terms of depiction of structures, image noise, and overall quality, using a 5-point scale (5 = better than FBP, 1 = poorer than FBP) to evaluate image quality. The other two radiologists placed regions of interest on the tympanic cavity and measured the standard deviation of CT attenuation (i.e., quantitative image noise). Scores from the qualitative and quantitative analyses of the DLR and HIR images were compared using, respectively, the Wilcoxon signed-rank test and the paired t-test. Results: Qualitative and quantitative image noise was significantly reduced in DLR images compared with HIR images (all comparisons, p ≤ 0.016). Depiction of the otic capsule, auditory ossicles, and tympanic membrane was significantly improved in DLR images compared with HIR images (both readers, p ≤ 0.003). Overall image quality was significantly superior in DLR images compared with HIR images (both readers, p < 0.001). Conclusion: Compared with HIR, DLR provided significantly better-quality high-resolution CT images of the temporal bone. [ABSTRACT FROM AUTHOR]

This article explores the evolution of mammalian teeth, jaw joints, and middle ear structures. It presents new evidence from fossil studies that sheds light on the earliest tooth diversification of mammaliaforms and the transformation of the reptilian jaw joint into the middle ear apparatus of mammals. The findings challenge previous understandings of tooth patterns and phylogenetic relationships among mammaliaforms. The article discusses the development of the dual jaw joint and the transition to the middle ear ossicles in mammals, as well as the role of Meckel's cartilage in this process. Overall, the available fossil evidence supports the gradual evolution from the dual jaw joint to the separate hearing and chewing apparatuses in mammals. [Extracted from the article]

Sound transmission to the human inner ear by bone conduction pathway with an implant attached to the otic capsule is a specific case where the cochlear response depends on the direction of the stimulating force. A finite element model of the temporal bone with the inner ear, no middle and outer ear structures, and an immobilized stapes footplate was used to assess the directional sensitivity of the cochlea. A concentrated mass represented the bone conduction implant. The harmonic analysis included seventeen frequencies within the hearing range and a full range of excitation directions. Two assessment criteria included: (1) bone vibrations of the round window edge in the direction perpendicular to its surface and (2) the fluid volume displacement of the round window membrane. The direction of maximum bone vibration at the round window edge was perpendicular to the round window. The maximum fluid volume displacement direction was nearly perpendicular to the modiolus axis, almost tangent to the stapes footplate, and inclined slightly to the round window. The direction perpendicular to the stapes footplate resulted in small cochlear responses for both criteria. A key factor responsible for directional sensitivity was the small distance of the excitation point from the cochlea. [ABSTRACT FROM AUTHOR]

Finite Element modeling has been an extended methodology to build numerical model to simulate the behavior of the hearing system. Due to the complexity of the system and the difficulties to reduce the uncertainties of the geometric data, they result in computationally expensive models, sometimes generic, representative of average geometries. It makes it difficult to validate the model with direct experimental data from the same specimen or to establish a patient‐oriented modeling strategy. In the present paper, a first attempt to automatize the process of model building is made. The source information is geometrical information obtained from CT of the different elements that compose the system. Importing that data, we have designed the complete procedure to build a model including tympanic membrane, ossicular chain and cavities. The methodology includes the proper coupling of all the elements and the generation of the corresponding finite element model. The whole automatic procedure is not complete, as we need to make some human‐assisted decisions; however, the model development time is reduced from 4 weeks to approximately 3 days. The goal of the modeling algorithm is to build a Finite Element Model with a limited computational cost. Several tasks as contour identification or model decimation are designed and integrated in order to follow a semi‐automated process that allows generating a patient‐oriented model. [ABSTRACT FROM AUTHOR]

Aims: In this study, we attempt to compare the pure tone audiometry findings with ossicular chain status intraoperatively in patients of chronic otitis media. Materials and methods: 102 patients who presented with COM during a period of one year and met the inclusion criteria were included in the study. All patients underwent preoperative pure tone Audiometry and findings were tabulated. All patients were evaluated intraoperatively by the same surgeon and observations were made regarding ossicular chain integrity. Results: Small central perforation was noted in 10%, medium central perforation in 38.57%, large central perforation in 27.14% and subtotal perforation in 24.28%. 71.56% patients had an intact ossicular chain, of which 94.5% was mucosal disease and 5.5% were squamous disease. 29 cases showed eroded/absent ossicles, out of which, 28 had squamous type and 1 case had central perforation. Ossicular status was classified based on Austin Classification. Conductive hearing loss was found to be maximum where all 3 ossicles were eroded/absent, with a mean AB gap of 45.33 and mean air conduction threshold of 60.33. Conclusion: There is a good correlation between the hearing threshold of the patient and the status of ossicular chain. Preoperative knowledge of the degree of hearing loss and status of ossicular chain would allow the surgeon to plan proper ossicular reconstruction and give the patient a better advice regarding prognosis of hearing improvement after surgery. [ABSTRACT FROM AUTHOR]

Elephants have a unique auditory system that is larger than any other terrestrial mammal. To quantify the impact of larger middle ear (ME) structures, we measured 3D ossicular motion and ME sound transmission in cadaveric temporal bones from both African and Asian elephants in response to air-conducted (AC) tonal pressure stimuli presented in the ear canal (PEC). Results were compared to similar measurements in humans. Velocities of the umbo (VU) and stapes (VST) were measured using a 3D laser Doppler vibrometer in the 7–13,000 Hz frequency range, stapes velocity serving as a measure of energy entering the cochlea—a proxy for hearing sensitivity. Below the elephant ME resonance frequency of about 300 Hz, the magnitude of VU/PEC was an order of magnitude greater than in human, and the magnitude of VST/PEC was 5x greater. Phase of VST/PEC above ME resonance indicated that the group delay in elephant was approximately double that of human, which may be related to the unexpectedly high magnitudes at high frequencies. A boost in sound transmission across the incus long process and stapes near 9 kHz was also observed. We discuss factors that contribute to differences in sound transmission between these two large mammals. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Although congenital middle ear anomalies include various types of ossicular anomalies, all of these can be treated by ossiculoplasty or stapes surgery. Transcanal endoscopic ear surgery (TEES) is a minimally invasive surgical method for middle ear disease with an excellent surgical view that has been widely adopted worldwide. To determine the efficacy of TEES for middle ear anomalies, we describe the surgical results and compare the hearing outcomes between patients treated by TEES and microscopic ear surgery (MES). A total of 39 ears with congenital middle ear anomalies were treated surgically at the University Hospital of Kochi Medical School between January 2011 and December 2021. In total, 29 ears of 23 patients were included in the study. Demographics, type of anomaly, surgical methods, pre- and postoperative hearing thresholds, and surgical complications were investigated by retrospective chart review. Of the 29 ears, 11 were treated by MES and 18 were treated by TEES. There were no differences in sex, age, preoperative hearing thresholds, or rate of stapes surgery between the two groups. The mean air-bone gap improvement was 20.6 dB in the MES group and 28.8 dB in the TEES group; these values were not significantly different. The median operation time was not significantly different between the MES and TEES groups (125 and 130 min, respectively). The improvements of air conduction in class 1 and 2 (stapes surgery) and class 3 (ossiculoplasty) cases were also not different between the groups. TEES achieved comparable hearing outcomes to MES without postauricular or endaural incisions. Further, class 1 and 2 anomalies demonstrated hearing improvement similar to class 3 without major complications. Since the surgical field limited around the ossicular chain, coupled with the fact that the middle ear anomaly itself does not exhibit inflammation leading to unfavorable bleeding, TEES is a feasible surgical procedure for all types of congenital ossicular anomalies. [ABSTRACT FROM AUTHOR]

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process. [ABSTRACT FROM AUTHOR]

Introduction: Congenital ossicular chain anomalies are rare conductive hearing loss conditions that remain difficult to diagnose even with high-resolution computed tomography (CT). The preoperative diagnosis is helpful for surgical planning and counseling patients regarding treatment outcomes. Case Presentation: We report a case involving a 14-year-old boy presenting with left conductive hearing loss without history of trauma for 5 years, physical examination showed normal otoscopic examination bilaterally and high-resolution CT showed absent of stapes suprastructure and footplate. Subsequent diagnosis was done via endoscopic middle ear exploration which revealed an absent long process of the incus, stapes suprastructure and footplate, but with intact oval window membrane. The residual incus was removed, and a tragal perichondrium graft was used over the oval window. A total ossicular replacement prosthesis was placed between the malleus and oval window to repair the chain. Postoperatively, the patient had no complications. Preoperative pure tone average revealed an air/bone result of 52/8 dB. Follow-up after surgery at 6 months showed a pure tone average air/bone result of 15/3 dB. The air-bone gap was reduced from 44 to 12 dB. Conclusion: Congenital absence of the stapes suprastructure and footplate remains a rare condition compared to the myriad of middle ear anomalies in the literature. [ABSTRACT FROM AUTHOR]

This article explores a rare congenital middle ear malformation known as congenital enlargement of the bony Eustachian tube (ET). The study examines the clinical and radiological features of nine patients with this condition and highlights the importance of diagnosing and treating it. The study found that all patients with enlarged bony ETs also had various malformations in the external, middle, and inner ears. The article provides measurements and images of the enlarged bony ETs, as well as details about other associated abnormalities. While this condition can cause hearing loss, more research is needed to fully understand it. [Extracted from the article]

The aim of this study was to evaluate the feasibility of ossiculoplasty via a minimally invasive endoscopic transtympanic approach (ETTA). We investigated the exposure of target structures (incus and stapes) on 4 human temporal bones by placing an endoscope into the middle ear cleft through the 4 tympanic quadrants. Then, on 3 additional specimens, we performed an incudostapedial disjunction and repaired it with a drop of hydroxyapatite cement via ETTA. We measured the size of tympanic perforation, and the acoustic transfer function of the middle ear (125–8000 Hz) before and after repair by placing an insert in the external auditory canal and recording the acoustic signal in the utricle by a microphone. The acoustic signal gain was estimated in dB μV. Exposure was similar in all four quadrants but ergonomics was better with a posteroinferior myringotomy. Ossicular chain repair was conducted successfully in all cases and the acoustic transfer function of the middle ear was significantly improved. Residual tympanic perforation (n = 3) was 2 ± 0.3 mm in diameter. ETTA to reconstruct incudostapedial joint with bone cement was feasible and effective. It opens perspectives for robot-based procedures guided by augmented reality. [ABSTRACT FROM AUTHOR]

The characterization of the vibrations of the middle ear ossicles during sound transmission is a focal point in clinical research. However, the small size of the structures, their micrometer-scale movement, and the deep-seated position of the middle ear within the temporal bone make these types of measurements extremely challenging. In this work, dynamic synchrotron-based X-ray phase-contrast microtomography is used on acoustically stimulated intact human ears, allowing for the three-dimensional visualization of entire human eardrums and ossicular chains in motion. A post-gating algorithm is used to temporally resolve the fast micromotions at 128 Hz, coupled with a high-throughput pipeline to process the large tomographic datasets. Seven ex-vivo fresh-frozen human temporal bones in healthy conditions are studied, and the rigid body motions of the ossicles are quantitatively delineated. Clinically relevant regions of the ossicular chain are tracked in 3D, and the amplitudes of their displacement are computed for two acoustic stimuli. Synchrotron X-ray imaging of stimulated human middle ears reveals the 3D movement of auditory ossicles: it enables their motion quantification, confirms the lever-like motions of the malleus and incus and reveals a more intricate stapedial behavior. [ABSTRACT FROM AUTHOR]

To study the morphology and anthropometry of human ear ossicles from cadaveric temporal bone and to study the variations of the human ossicles from ossiculoplasty point of view. 38 sets of ear ossicles were collected, each containing malleus, incus and stapes, from temporal bone dissection done in Vasantrao Pawar medical college, Nashik. They were studied under microscope & anthropometrical, morphological evaluation done. Malleus showed variations in handle where 61% were straight and 39% curved. Weight of malleus ranged from 0.03–0.06 gm. The length ranged from 5.5 to 8.2 mm. Incus showed morphological variation in lenticular process which was present in 73% incii. Weight of incus ranged from 0.04 to 0.09 gm, average length of long process 3.5 mm, width of body 4 mm. In stapes variations was seen with head of stapes which was absent in 21% bones. With increasing awareness about postop hearing status, this study will add up in knowledge of morphological and anthropometric variations that exists in Indian population, help otologists to understand middle ear dynamics better which will improve results of ossiculoplasty. [ABSTRACT FROM AUTHOR]

Introduction: Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft. Mastoidectomy, with or without tympanoplasty, is the preferred treatment for CSOM. However, the drill used during ear surgery generates noise that may potentially cause hearing damage in both the operated and opposite inner ear, leading to temporary or permanent hearing loss. Materials and Methods: The study included patients diagnosed with CSOM who underwent surgeries in the Otorhinolaryngology department. Postoperatively, all patients were followed up on the 7th day and 1 month after the surgery. Pure Tone Audiometry (PTA) was performed to evaluate the hearing outcomes. Results: A total of 61 patients were included in the study. The mean preoperative PTA of contralateral ear bone conduction among the study participants was 6.48. At the 7th day post-operation, the mean post-operative PTA of contralateral ear bone conduction for the same participants was 7.77. This difference was statistically significant according to the Paired T-test (P = 0.001).However, when evaluating the mean preoperative PTA of contralateral ear bone conduction (6.48) and the mean post-operative PTA at 1st month (6.02), the difference was not statistically significant (P = 0.208).Additionally, there was no statistical difference in air conduction and air-bone gap before and after surgery. Conclusion: The study suggests that mastoid drilling is associated with a significant temporary hearing loss in the contralateral ear immediately after surgery, which eventually recovers within a month. However, the hearing loss is considered negligible and not statistically significant in the long term. It is worth considering additional audiological investigations, such as otoacoustic emissions, to detect this type of hearing loss more accurately. [ABSTRACT FROM AUTHOR]

It is important to know the morphometry of the auditory ossicles for middle ear surgical applications. The present study aims to investigate the morphometric measurements of sheep auditory ossicles and the relationship between these ossicles. In this study, 100 malleus, incus and stapes of 50 Akkaraman sheep were examined using at trinocular stereo microscope and a total of 19 morphometric measurements were taken. The mean values of the morphometric measurements were obtained, and correlation analysis was performed between each part of each auditory ossicle. Similarities were found between the measurements of the lengths of the malleus, manubrium mallei and incus, and the width of the base of the stapes with morphometric measurements in human auditory ossicles. A significant positive correlation was found between the length of the malleus with the length of the manubrium mallei, between the length of the incus with the lengths of the long crus and corpus incudis, between the length of the stapes with the lengths of the rostral crus, caudal crus, caput stapedis, and the length and width of the intercrural foramen. Due to the anatomic similarities between sheep and human auditory ossicles, it was concluded that the auditory ossicles of sheep are suitable for use in the training of human ear surgery applications. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media (CSOM) is a common problem affecting middle ear and it’s commonly presented with chronic ear discharge and decreased hearing. Hearing problem in CSOM is primarily caused perforated tympanic membrane and in some cases by the presence of erosion of the ossicular chain. The study aimed to show the rate and site of ossicular chain erosion in patients with chronic suppurative otitis media underwent tympanomastoid surgery. Patient and methods: a cross sectional study conducted on 87 patients performed tympanomastoid surgery for chronic middle ear infection where their ossicular status has been assessed intraoperatively. Results: our study shows that 40% of the operated ears has at least a single bone erosion and the Incus bone was the most affected ossicle while the Malleus was the least one 54% and 14% respectively. No statistically significant difference was seen between bone erosion and gender as well as the side of operation. Conclusion: ossicular erosion is a common problem affecting patient with chronic suppurative otitis media and the surgeons should be aware about this pathology and they should have the proper skill to correct such problem. [ABSTRACT FROM AUTHOR]

The advancement of technology in the field of human health plays a significant and positive role, particularly in the realm of hearing. In this study, we propose a novel approach for middle ear prostheses. We constructed a finite element (FE) model of the ear with a pure titanium TORP prosthesis, which we validated using experimental results. Subsequently, we applied the FGM (material degradation) method to alter the prosthesis material, utilizing biocompatible materials that can be used as hearing prostheses. We found that steel and hydroxyapatite ceramic can be used as alloys with titanium, and even customized prostheses can be manufactured according to patients' needs. [ABSTRACT FROM AUTHOR]

The temporal bone is a complex anatomical space that houses the middle ear and its ossicles, as well as the inner ear, which includes the vestibule, cochlea, and the semicircular canals. Henle's spine, also known as the suprameatal spine/spina suprameatica/ is found to guide the lateral wall of the mastoid antrum [J Res Med Dent Sci 8(7):420–422, Stat-Pearls Publishing, Treasure Island. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559153/]. It is found that the Henle's spine is present in 85% of the human skulls and when present, it could be used as a reliable anatomical landmark for isolating various foramina during skull base surgeries [J Laryngol Otol 119:856–861], and to assess the location of handle of malleus and subsequently the mastoid antrum, in many cases. We present here 3 cases in which tympanoplasty was planned, and the position of spine of Henle was found to be anterosuperior and so was the handle of malleus. Antrostomy was done by following the spine of Henle in all cases to establish patency and maintain ventilation in the post-operative ear. These 3 cases had a much more anteriorly placed spine. Such cases need to be reported so that it creates a paradigm shift in the way that mastoid surgeries are being done. Any variation in the positioning of the spine of henle points to variability in the position of the mastoid antrum. This is extremely important while drilling the mastoid in the correct position and also to prevent drilling over the sigmoid sinus or the dura. To conclude, an anteriorly placed spine of Henle corresponds to anteriorly placed mastoid antrum. [ABSTRACT FROM AUTHOR]

Ossiculoplasty is a surgical operation performed to restore auditory transmission through the reconstruction of the ossicular chain using prosthetics. Tissue bioengineering has assumed a pivotal role in implementing alternatives to conventional ossicular middle ear replacement prostheses, to overcome extrusion while preserving acoustic properties. This in vitro study aims to explore, for the first time in current literature, the feasibility of a biohybrid middle ear prosthesis, composed of titanium surrounded by a bone extracellular matrix as bio-coating. We have hereby studied the adhesion and proliferation of human adipose-derived mesenchymal stem cells (hASC) on titanium scaffolds in vitro. Moreover, we identified the osteogenic differentiation of hASC using an immunofluorescence assay to analyze osteoblasts' gene expression profiles (Alp, Runx2, Col1a1, Osx, and Bglap), and we counted the presence of collagen as a marker of hASC's ability to secrete an extracellular matrix. We utilized scanning electron microscopy to evaluate the presence of an extracellular matrix on the scaffolds. Our preliminary data demonstrated the titanium's ability to support human adipose-derived mesenchymal stem cell colonization, proliferation, and osteoblastic differentiation, in order to obtain a biohybrid device. Our experience seems encouraging; thus, we advocate for further in vivo research to corroborate our results regarding bone transplantation. [ABSTRACT FROM AUTHOR]

Imaging of the temporal bone and middle ear is challenging for radiologists due to the abundance of distinct anatomical structures and the plethora of possible pathologies. The basis for a precise diagnosis is knowledge of the underlying anatomy as well as the clinical presentation and the individual patient's otological status. In this article, we aimed to summarize the most common inflammatory lesions of the temporal bone and middle ear, describe their specific imaging characteristics, and highlight their differential diagnoses. First, we introduce anatomical and imaging fundamentals. Additionally, a point-to-point comparison of the radiological and histological features of the wide spectrum of inflammatory diseases of the temporal bone and middle ear in context with a review of the current literature and current trends is given. [ABSTRACT FROM AUTHOR]

The accurate estimation of the ossicular chain abnormalities using existing functional examinations has been difficult. This study aimed to verify the accuracy of preoperative diagnosis of ossicular chain abnormalities using a wideband frequency impedance (WFI) meter, which can measure the dynamic characteristics of the middle ear. Retrospective cohort study. Fourteen ears of patients with ossicular chain abnormalities that were definitively diagnosed surgically were included in this study. The following data were collected for each participant: sound pressure level (SPL) curve measured using the WFI meter and a sweep frequency impedance (SFI) meter, WFI measurements plotted on the resonance frequency (RF)-ΔSPL plane, distribution map of the dynamic characteristics of the middle ear, preoperative audiometry results, and the definitive surgical diagnosis. The SPL curve obtained using the WFI meter had lesser noise than that obtained using the SFI meter. The distribution map revealed that the ossicular chain separation range and ossicular chain fixation range were completely separated. The hearing data tended to be poor in cases with small ΔSPL. WFI can potentially enhance the accuracy of SFI. In addition, it can also be used for the classification of ossicular chain separation and fixation as well as the quantification of fixation in cases of ossicular chain anomalies that cannot be diagnosed using conventional tests. [ABSTRACT FROM AUTHOR]

Objective: To assess the prognostic factors for anatomic and hearing success after tympanoplasty in the setting of complex middle ear pathology. Methods: A systematic review was performed in January 2022. English-language articles describing outcome data for tympanoplasty repair variables including underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Articles were included when tympanosclerosis, retraction pockets, adhesions, cholesteatoma, chronic suppurative otitis media, anterior perforations, and smoking were included. Underlying pathology, perforation location, smoking status, graft technique, reconstruction material, anatomic success, and hearing success were extracted. Any factors analyzed as potential indicators of success were sought out. Results: Data sources included PubMed, OVID, Cochrane, Web of Science, Scopus, and manual search of bibliographies. Ninety-three articles met final criteria, which accounted for 6685 patients. Fifty articles presented data on both anatomic and hearing outcomes, 32 articles presented data on anatomic outcomes only, and 11 articles presented data on hearing outcomes only. This systematic review found that adhesions and tympanosclerosis were prognostic factors for poorer hearing. Additionally, smoking and tympanosclerosis may be predictive of anatomic failure; however, the significance of this finding was mixed in included studies. This analysis is significantly limited by both the heterogeneity within the patients and the lack of controls. Conclusion: Adhesions and tympanosclerosis were prognostic factors for poorer hearing. Clearly documented methods and outcomes for the included pathologies could lead to more definitive conclusions regarding prognostic factors for success. Level of Evidence: 3B [ABSTRACT FROM AUTHOR]

Objective: Attic retraction pockets, classified by degree of invasion and erosion, are reconstructed here as outlined by attic retraction pocket grade. Method: Attic retraction pocket grade, surgical management, subsequent conditions of tympanic membrane and middle ear, and improvement of air–bone gap pure tone average were recorded. Results: Our management strategy, based on attic retraction pocket grade, was applied to 200 ears: 44 grade I ears had non-surgical management and 156 grade II–V ears had surgical management. All 200 ears were followed up for 36–240 months, showing only 1 attic retraction pocket reformation and 1 adhesive otitis media (complication rate of 1 per cent), and improved air–bone gaps (p < 0.05). An earlier series of 50 grade IV attic retraction pockets used atticotomy with epitympanic reconstruction. These showed attic retraction pocket recurrence or cholesteatoma onset in 34 ears (68 per cent). When these ears were revised per protocol, there was no evidence of cholesteatoma thereafter. Conclusion: Reconstruction of the ossicles and scutal defect according to attic retraction pocket grade shows long-term stability of the tympanic membrane, middle ear and hearing. [ABSTRACT FROM AUTHOR]

The middle ear ossicles in modern mammals are repurposed from postdentary bones in non-mammalian cynodonts. Recent discoveries by palaeontological and embryonic studies have developed different models for the middle ear evolution in mammaliaforms. However, little is known about the evolutionary scenario of the middle ear in early therians. Here we report a detached middle ear preserved in a new eutherian mammal from the Early Cretaceous Jehol Biota. The well-preserved articulation of the malleus and incus suggest that the saddle-shaped incudomallear joint is a major apomorphy of Early Cretaceous eutherians. By contrast to the distinct saddle-like incudomallear articulation in therians, differences between the overlapping versus the half-overlapping incudomallear joints in monotremes and stem mammals would be relatively minor. The middle ear belongs to the microtype by definition, indicating its adaptation to high-frequency hearing. Current evidence indicates that significant evolutionary innovations of the middle ear in modern therians evolved in Early Cretaceous. The evolution of the middle ear in early therians is unclear. Here, the authors report a reconstructed, detached middle ear in a eutherian mammal from the Early Cretaceous Jehol Biota, suggesting independent decoupling of hearing and chewing apparatuses. [ABSTRACT FROM AUTHOR]

Introduction: Malleus is one of the three ear ossicles which are the largest among all. It is present in the middle ear cavity and is responsible for the conduction of sound waves from external to inner ear. The malleus has a head, neck, manubrium, and anterior and lateral processes. The aim of this study was to study the morphometry of human malleus and to determine the normal range of the various measurements of malleus. Materials and Methods: A total of 120 dry adult human mallei were used in this study. Malleus bones were collected during the routine dissection of cadavers by the MBBS students of first professional in the dissection hall of anatomy department of various medical colleges of Uttar Pradesh. These dimensions of malleus bone were taken with the help of digital Vernier caliper which has an accuracy of 0.01 mm. Results: The mean value of total length of malleus was found 7.915 mm, mean value of length of handle was found 4.74 mm, and mean value of total width of head was found 2.63 mm. Discussion and Conclusion: No statistical significant difference was found when compared with the morphometric parameters of malleus of the right and left sides. [ABSTRACT FROM AUTHOR]

Objective: To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia. Data sources: Pubmed/Medline, Embase and Cochrane library. Review methods: Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss. Results: Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and − 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0–33.3% of ears, and recurrence of hearing loss occurred in 0–66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss. Conclusion: Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL. Level of evidence: 2c. [ABSTRACT FROM AUTHOR]

Ossicular chain disruption is a typical consequence of temporal bone trauma. However, it can also occur as a result of direct trauma to the ossicular chain due to penetrating injuries. Hearing loss, dizziness, and facial nerve damage could also occur after penetrating middle ear injuries. Multiple ossicular chain disruption is a rare traumatic ossicular complication caused by direct penetrating lesions in the external auditory canal. We present two cases of multiple ossicular disruptions (dislocation of the incudostapedial and malleoincudal joints) after ear-pick injuries, both of which resulted in conductive hearing loss. The condition improved after delayed surgical intervention (ossiculoplasty). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the effectiveness of auditory brainstem response (ABR) and extracochlear electrocochleography (ECochG) in objectively evaluating the coupling effciency of floating mass transducer (FMT) placement during active middle ear implant (AMEI) surgery. Methods: We enrolled 15 patients (mean age 58.5 ± 19.4 years) with mixed hearing loss who underwent AMEI implantation (seven ossicular chain and eight round window couplings). Before the surgical procedure, an audiogram was performed. We utilized a clinical measurement system to stimulate and record intraoperative ABR and ECochGrecordings. The coupling effciency of the VSB was evaluated through ECochG and ABR thresholdmeasurements. Postoperatively, we conducted an audiogram and a vibrogram. Results: In all 15 patients, ABR threshold testing successfully determined intraoperative coupling effciency, while ECochG was successful in only eight patients. In our cohort, ABR measurements were more practical, consistent, and robust than ECochG measurements. Coupling effciency, calculated as the difference between vibrogram thresholds and postoperative bone conduction thresholds, was found to be more accurately predicted by ABR measurements (p = 0.016, R² = 0.37) than ECochG measurements (p = 0.761, R² = 0.02). We also found a non-significant trend toward better results with ossicular chain coupling compared to round window coupling. Conclusion: Our findings suggest that ABR measurements are more practical, robust, and consistent than ECochG measurements for determining coupling effciency during FMT placement surgery. The use of ABR measurements can help to identify the optimal FMT placement, especially with round window coupling. Finally, we offer normative data for both techniques, which can aid other clinical centers in using intraoperative monitoring for AMEI placement. [ABSTRACT FROM AUTHOR]

Previous studies of the middle ear in Chronic Otitis Media have focussed on radiological assessment of temporal bone; endoscopic studies were focussed on perforation size and location. The malleus handle (manubrium) is a constant ossicular feature visible on otoendoscopy. It's relative position may indicate the previously documented differences in ossicular chain and middle ear cleft development relative to the tympanic ring and inner ear capsule between affected ear and contralateral ear. Design: descriptive. Setting: hospital based. Subjects: 84 patients with unilateral mucosal chronic otitis media. Methods: each patient underwent Otoendoscopy and the findings were recorded through a camera connected to a laptop. Using image j software these images were analysed. Participants were of mean age of 35 years with left preponderance, and no gender preponderance was found. In our study, majority of the perforations were small sized perforations. The malleus handle foreshortening was about 92.6% compared to unaffected ear which was statistically insignificant. There was a significant inter group difference in the distance between the tip of the manubrium and the inferior annulus—which was decreased in affected ears and in the distance from the lateral process to the anterior tympanic ring—which was increased in affected ears. There was no difference in the malleo scutal angles. These differences were not dependent on the site or size of the perforation. The differences we found between ears were unexpected. The significance of the differences in the shape of the tympanic membrane between affected and unaffected ears in unilateral mucosal COM need further study. We did not find a statistically significant difference in the malleo-scutal angles between ears. [ABSTRACT FROM AUTHOR]

We present a semi-automatic reconstruction approach of middle and inner ear structures using generic 3D deformable surface models from Cone Beam CT (CBCT) examination. First, the user must position a set of control points in the CBCT volume for each of the 4 structures of the inner and middle ear. These points are used to position the deformable surface models and to customize them so that they are as close to the boundaries as possible. Finally, each mesh is refined iteratively segmenting the limits of the structure while taking into account neighbouring structures as boundary constraints. Our method is tested on left and right ears of 20 scans of patients analysed retrospectively. The results show the efficiency and reliability of this approach with an average Dice Similarity Coefficient of 91.8% for the inner ear model and 89.9% for the ossicular chain and a total reconstruction time of 5 minutes. The implementation of our method in a clinical setting could provide clinicians with distinct and accurate 3D models of the ear structures without requiring a tedious manual segmentation step, in order to give them a better understanding of the auditory system in vivo and help them in diagnosis and follow-up. [ABSTRACT FROM AUTHOR]

In the last decades, finite-element models of the middle ear have been widely used to predict the middle-ear vibration outputs. Even with the simplest linear assumption for material properties of the structures in the middle ear, these models need tens of parameters. Due to the complexities of measurements of material properties of these structures, accurate estimations of the values of most of these parameters are not possible. In this study, we benefited from the stochastic finite-element model of the middle ear we had developed in the past, to perform global sensitivity analysis. For this aim, we implemented Sobol′ sensitivity analysis which ranks the importance of all uncertain parameters and interactions among them at different frequencies. To decrease the computational costs, we found Sobol′ indices from surrogate models that we created using stochastic finite-element results and the polynomial chaos expansion method. Based on the results, the Young's modulus and thickness of the tympanic membrane, Young's modulus and damping of the stapedial annular ligaments, and the Young's modulus of ossicles are among the parameters with the greatest impacts on vibrations of the umbo and stapes footplate. Furthermore, the most significant interactions happen between the Young's modulus and thickness of the tympanic membrane. [ABSTRACT FROM AUTHOR]

Active bone-conducting hearing devices (aBCHD; e.g., MEDEL Bonebridge® (BB)) and active middle ear implants (aMEI; e.g., MEDEL Vibrant Soundbridge® (VSB)) use radio frequency transmission to send information from an external microphone and sound processor to an internally implanted transducer. These devices potentially have an advantage over devices with percutaneous links because the skin is closed over the implantable components, which should reduce the risk of skin problems and infection. On the other hand, surgical procedures are more complex, with a greater risk of damage due to surgery. The objectives of this research were to quantify the reliability and long-term survival of MEDEL VSB and BB devices, determine the adverse and serious adverse device-related complications, and consider associated causes. A multi-center observational retrospective and prospective study was conducted at eleven auditory implant centers in the United Kingdom. Data was collected using a surgical questionnaire and audiological reports. Data were obtained from patient notes or from prospective cases that had a minimum follow-up of one year post-implant. Consecutive patient records were reviewed. Datasets from 109 BB and 163 VSB were reviewed. Of these, 205 were retrospective case note reviews, and 67 were prospective cases. The mean follow-up was 4 and 6 years, respectively, for BB and VSB. Kaplan–Meier Survival analyses indicated that the BB survival was 97% and 93.3% at 1 and 5 years, respectively, and the VSB was 92.1% and 87% at the same time points. This is a large cohort study for the field and has indicated that BB and VSB are safe interventions. Care should be taken to monitor magnet strength in the first few months. For the majority of device-related effects, there was no apparent association with etiology. However, an interesting pattern emerged for individuals who exhibited an inflammatory response, e.g., adhesions or device extrusion, and those with a history of chronic suppurative otitis media. This should be considered in future work and is not surprising given that many VSB recipients have a complicated hearing history, often associated with otitis media. [ABSTRACT FROM AUTHOR]

Modularity (segmentation), homology and heterochrony were essential concepts embraced by Gavin de Beer in his studies of the development and evolution of the vertebrate skull. While his pioneering contributions have stood the test of time, our understanding of the biological processes that underlie each concept has evolved. We assess de Beer's initial training as an experimental embryologist; his switch to comparative and descriptive studies of skulls, jaws and middle ear ossicles; and his later research on the mammalian skull, including his approach to head segmentation. The role of cells of neural crest and mesodermal origin in skull development, and developmental, palaeontological and molecular evidence for the origin of middle ear ossicles in the evolutionary transition from reptiles to mammals are used to illustrate our current understanding of modularity, homology and heterochrony. This article is part of the theme issue 'The mammalian skull: development, structure and function'. [ABSTRACT FROM AUTHOR]

Current clinical tests for middle ear (ME) injuries and related conductive hearing loss (CHL) are lengthy and costly, lacking the ability to noninvasively evaluate both structure and function in real time. Optical coherence tomography (OCT) provides both, but its application to the audiological clinic is currently limited. Adapt and use a commercial Spectral-Domain OCT (SD-OCT) to evaluate anatomy and sound-evoked vibrations of the tympanic membrane (TM) and ossicles in the human ME. SD-OCT was used to capture high-resolution three-dimensional (3D) ME images and measure sound-induced vibrations of the TM and ossicles in fresh human temporal bones. The 3D images provided thickness maps of the TM. The system was, with some software adaptations, also capable of phase-sensitive vibrometry. Measurements revealed several modes of TM vibration that became more complex with frequency. Vibrations were also measured from the incus, through the TM. This quantified ME sound transmission, which is the essential measure to assess CHL. We adapted a commercial SD-OCT to visualize the anatomy and function of the human ME. OCT has the potential to revolutionize point-of-care assessment of ME disruptions that lead to CHL which are otherwise indistinguishable via otoscopy. [ABSTRACT FROM AUTHOR]

Background: Chronic suppurative otitis media is one of the most common childhood infections worldwide and represents a leading cause of hearing impairment in resource-limited settings. Although a clinical diagnosis, imaging plays a crucial role in cases where there is suspicion of cholesteotoma and to look for the associated intracranial complications, which may otherwise prove fatal. Due to its excellent spatial resolution, HRCT has emerged as the modality of choice in diagnosing, surgical decisions, and further follow-up of patients. Aims and Objectives: The present study aimed to study the radiological findings in the temporal bone in patients with CSOM, to look at the extent and sites of involvement in the middle ear and mastoid air cells, and to look for the complications of CSOM (if any). Materials and methods: 150 patients referred for HRCT evaluation to the Radiology department over 1 year were enrolled in the study. HRCT evaluation of the study participants was done as per the set temporal bone protocol. The contrast was administered only in those patients where there was suspicion of intracranial complications. The HRCT images were evaluated for the presence or absence of abnormal soft tissue density, the status of the ossicles & the integrity of the ossicular chain, the integrity of the bony landmarks including the scutum, tegmen, mastoid cotes, & sigmoid sinus plate. Assessment of the mastoid pneumatisation was done in all cases. Results: The mean age in our study population was 24.81 years. The majority of the patients belonged to the age group of 21-30 years. In our study, males were affected more frequently than females. The most common presenting complaints were ear discharge, decreased hearing, and ear aches. On HRCT evaluation, abnormal soft tissue density was seen in 100 cases(66.67%), with involvement of mastoid antrum and aditus ad antrum in all cases, followed by epitympanum, mesotympanum, and hypotympanum in that order. Ossicular erosions were seen in 89 cases(59.33%), with incus being the most frequently involved ossicle, followed by stapes malleus in that order. Scutum erosions were seen in 70 cases (46.67%) and erosions of the tegmen were seen in 38 cases (25.33%). Facial canal dehiscence/erosions were seen in 20 cases (13.33%). Mastoid cortex & sinus plate erosions were seen in 3 cases each (2%). Labrynthine fistula & extratemporal complications were noted in 2 patients each (1.33%). Conclusions: HRCT of the temporal bone is an efficacious modality for the accurate delineation of the anatomy and pathological involvement of the temporal bone. It is a unique method to detect early cholesteotoma & also to detect cholesteotoma in hidden areas. HRCT is useful for diagnosis, surgical planning & management of temporal bone pathologies. [ABSTRACT FROM AUTHOR]

Objective: To correlate high-resolution computed tomography (HRCT) imaging findings of chronic otitis media (COM) with and without cholesteatoma regarding the presence, site, and severity of bone defects. Material and Methods: Temporal bone HRCT images of patients with COM, obtained between 2011 and 2022, were retrospectively reviewed. Patients with a soft tissue mass in the tympanic cavity were allocated into either COM with cholesteatoma (CH+COM) or without cholesteatoma group (CH-COM) based on pathology results and-/or magnetic resonance imaging findings. Computed tomography images were analyzed with regard to the presence, site, and severity of middle ear bone erosions/defects and group comparisons were made. Results: A total of 60 patients (CH+COM: 23 patients, CH-COM: 37 patients) were included. Blunting of the scutum, defect of the tegmen tympani, absence/incompleteness of the Körner's septum, erosion of the ossicular chain, and destruction of the medial and lateral tympanic walls were significantly more frequent in the CH+COM group (p<0.05). While small bone discontinuities (=2 mm) of the tegmen tympani or blunting of the scutum were present in both groups, a greater defect of these structures was observed only in the CH+COM group. No significant difference was detected neither regarding the location of the soft tissue masses nor the presence of posterior wall defects (p>0.05). Conclusion: Radiologists should be aware of bone erosions when evaluating temporal bone HRCT images of patients with COM, even if cholesteatoma is not suspected. Furthermore, reporting the severity of bone destruction could be a helpful hint regarding the presence of cholesteatoma and might impact surgical planning. [ABSTRACT FROM AUTHOR]

Introduction: Chronic suppurative otitis media (CSOM) refers to a chronic infection of the mucosa lining the middle ear cleft. CSOM is characterized by chronic inflammation of the middle ear and mastoid mucosa. Active mucosal CSOM is often associated with resorption of parts or all of the ossicular chain (resorptive osteititis). Resorption of bone is a feature of active mucosal and active squamous epithelial CSOM. Materials and methods: This was a Cross Sectional Analytical study conducted in the Department of ENT of KPM Hospital, Kanpur, UP from November 2021 to October 2022. As it was a time bound study, every consecutive patient of mucosal type of Chronic Suppurative Otitis Media (CSOM) fulfilling inclusion criteria were selected for the study. Patients of either sex and age above 15 years to 60 years having inactive mucosal type of Chronic Suppurative Otitis Media with pure conductive hearing loss and functioning Eustachian tube posted for Tympanoplasty were included in the study. Whereas the patients who were with squamosal type of CSOM and previous history of ear surgery in the same ear were excluded from the study. An informed written consent was taken before the conduct of the study. Results: Ossicular necrosis was noted in 10 (23.33%) of total 45 patients. On statistical analysis, patients of age >30 years (p=0.019, duration of ear discharge >10 years (p=0.003), those having large and subtotal perforation (p<0.001), adhesion of tympanic membrane edges to promontory (p=0.04), incudostapaedial joint area exposure (p=0.01) and air-one gap >40 dB (p <0.001) were found to be statistically significantly associated with ossicular erosion. Conclusion: All patients of mucosal type of chronic suppurative otitis media should be assessed in detail so as to get a clue of ossicular defects to be prepared for its repair and will not come as a surprise during surgery. [ABSTRACT FROM AUTHOR]

Objective(s): This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children. Methods: The clinical records of children diagnosed with CG were retrospectively reviewed. Results: The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12–24 months. Conclusion(s): The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children. [ABSTRACT FROM AUTHOR]

The study provides a series of distinctive morphological features of the auditory ossicles alongside comparative morphometric data, bringing facts in respect to morphology and some morpho-functional elements of the auditory ossicles in this little-studied species. The most relevant features noted are evident conical shape of muscular process of malleus and triangular aspect of the handle of malleus. For the incus, a short body of the bone and the direct continuation is mentioned, with no clear distinction as an individualized piece for the lenticular process. As for the stapes, the clear profiling of the muscular tubercle for the stapedial muscle and elliptic shape of the foot of the stapes is noted. A series of comparative measurements and indices are also calculated in the attempt of profiling differences from the domestic couterspecies- sheep and goat.

Introduction:We aimed to compare the effectiveness of wideband absorbance in detecting ossicular chain discontinuity with intraoperative findings.Materials and Methods:In this study, 58 ears from 38 patients with chronic otitis media (COM) were included. Twenty-six ears with perforation and intact ossicular chain were determined as Group 1, 12 ears with perforation and ossicular chain defects were determined as Group 2, and 20 ears with normal hearing and intact tympanic membrane were determined as Group 3. The comparison of the groups was made considering the static (non-pressure) absorbance analysis performed using wideband tympanometry.Results:When perforation sites were evaluated in Group 1 and Group 2; there were 12 anterior perforations, 7 posterior perforations, and 19 subtotal perforations. Air conduction thresholds in Group 2 were significantly (P0.05) was found between the frequencies 226 to 1000 Hz. WBA measurements at 8 frequencies between 1888-2311 Hz in Group 1 were significantly lower than Group 3 (P