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Objective To describe a transoral approach for tympanic bulla osteotomy in the dog. Study design Anatomic cadaveric study. Sample population Fifteen canine cadavers (n = 29 tympanic bullae), including mesaticephalic, dolichocephalic, and brachycephalic breeds. Materials and methods The oral surface of the tympanic bulla was identified during an anatomical study (3 canine cadavers) and the ventral approach to the tympanic bulla was described (3 canine cadavers). The safety of the technique was assessed (9 canine cadavers, n = 17 bullae) during further anatomical dissections, where a complete approach and drilling of the tympanic bulla were performed. Results In all cases, tympanic bulla osteotomy was performed without damaging the inner ear, the epitympanic recess contents, and the neurovascular structures. The oral approach to the tympanic bulla was easier in mesaticephalic and dolichocephalic dogs than in brachycephalic breeds. Conclusion This study defines anatomical landmarks for transoral bulla osteotomy, without a high risk of damage to neurovascular and anatomical structures within and/or surrounding the tympanic cavity. This minimally invasive approach to the tympanic bulla is performed via a natural opening, and does not require simultaneous access through the ear canal. In vivo evaluation of this technique is required to verify its safety in clinical cases prior to large scale application.

Congenital cholesteatomas are epithelial cell rests found within the middle ear or mastoid that are present behind an intact tympanic membrane. Typically found early in life, these expansile skin cysts can result in conductive hearing loss by impeding or eroding the ossicular chain. If left unaddressed, congenital cholesteatoma can result in erosion of the bony labyrinth, tegmen, or facial nerve resulting in significant patient morbidity. Surgical removal of congenital cholesteatoma is recommended, preferably when the lesions are small. When considering a surgical approach for the removal of congenital cholesteatoma, surgeons should consider the size and location of the lesion as well as the extent of expected reconstruction. Transcanal endoscopic ear surgery can successfully be used to manage congenital cholesteatoma limited to the tympanic cavity. Patient features that favor an endoscopic approach include a circumscribed, unruptured congenital cholesteatoma, intact external auditory canal wall, and absence of secondary complications such as labyrinthine fistula, middle fossa extension, or facial nerve paresis. We describe our endoscopic operative approach to remove congenital cholesteatoma and also highlight effective methods of tympanic reconstruction.

The aim of this review is to describe and evaluate transcanal endoscopic technique for treatment of acquired Cholesteatoma. This article discusses advantages of endoscopic ear surgery in treating Cholesteatoma and how the hidden sites like the facial recess, sinus tympani, and anterior epitympanum are easily accessed using the endoscope thereby reducing residual Cholesteatoma. Additionally, endoscopic techniques allow better access to the tympanic cavity and protympanum, which translates into better understanding of the etiology of ventilation and reduces recurrent disease. The transcanal endoscopic approach allows minimally invasive removal of Cholesteatoma with results that compare well to traditional postauricular tympanomastoidectomy.

Diseases of the ear are common in pet rabbits. The basic anatomy of the "standard" rabbit is similar to the canine and feline ear; however, there are a few important differences. Otitis refers to inflammation of one or more structure of the ear and includes otitis externa (the ear canal), otitis media (tympanic membrane, bony acoustic duct, and tympanic cavity), and otitis interna (inner ear). Etiology and clinical presentations of the different classifications of otitis in rabbits are revised in this article. Available techniques for a thorough diagnostic work up and recommendations for a tailored medical treatment are presented from the available literature. Numerous surgical techniques have been described for management of ear disease in dogs, and many have been extrapolated for use in rabbits, occasionally without considering significant differences in anatomy between species, especially in the lop rabbit. The authors report both the advantages and disadvantages associated with the available surgical techniques that have been described to treat rabbit ear disease. Because of limited case numbers and follow-up data, retrospective information on long-term outcome for these procedures is not available.

The research purpose is to study the structure of the middle ear of the Baikal seal. It consists of an eardrum and auditory ossicles located in the tympanic cavity. The Baikal seal has a triangular-shaped drum bubble. At the top of the tympanic cavity, the Eustachian tube is located. Another feature of the tympanic cavity is a bone roller of the carotid artery which has not been found in other seals. Passing through the roller, the carotid artery does not enter the tympanic cavity. There are differences in the structure of the auditory ossicles: on the external surface of the malleus head, there is a recess; the joint between the malleus head and the anvil is quite mobile, which makes it easy to separate the auditory ossicles; the stirrup is light and of a triangular shape; legs of the stapes differ in thickness; the lenticular bone which serves as a joint between the long leg of the anvil and the stirrup, is well seen. At the lateral side of the bony cape, there is an oval vestibule window closed by the stirrups. The cochlea window is covered with an internal mucous membrane of the tympanic cavity and its own membrane.

Background The Eustachian tube connects the tympanic cavity (cavum tympani) and the nasopharynx, and enables pressure equalization between the middle ear and ambient pressure. Functional pressure compensation is very important for flying and diving in particular, due to non-physiologically large pressure differences. Objective Evaluation of the pressure-equalizing function of the Eustachian tube is still a clinical challenge. This review article evaluates the existing data. Methods Based on a selective literature search, different methods for evaluation of tube function are presented and evaluated, with special reference to evaluation of the pressure-equalizing function in a hypo-/hyperbaric pressure chamber. Results The pressure chamber enables the dynamics of active and passive pressure compensation to be provoked and also permits accurate measurement of pressures in the millibar range. Conclusion A pressure chamber seems to be suitable to evaluate Eustachian tube function and therapeutic approaches to tube dysfunction. Further studies are needed to assess the value of the pressure chamber in combination with other functional tests.

Objective Compared to canal wall up (CWU) tympanoplasty, canal wall reconstruction (CWR) allows better visualization of cholesteatoma extension. The canal wall up approach provides good functional outcomes, but with higher rates of residual cholesteatoma. The aim of this study was to compare residual cholesteatoma prevalence and location between the two approaches. Method Subjects were adult patients with residual cholesteatoma following CWU or CWR surgery between January 1, 2010 and December 31, 2015. During this period, 94 patients underwent CWU and 71 CWR; 22 presented with residual cholesteatoma: 16 after CWU (R-CWU group) and 6 after CWR (R-CWR group). Results There was no significant inter-group difference in residual cholesteatoma prevalence: 17% after CWU, 8.4% after CWR. Locations comprised: 13 (81%) in the attic, 9 (56%) in the tympanic cavity and 4 (25%) in the mastoid in the R-CWU group, and 6 (100%) in the attic in the R-CWR group. There were significantly fewer tympanic cavity locations after CWR compared to CWU (P = 0.046). Conclusion Residual cholesteatoma prevalence did not significantly differ between the CWU and CWR approaches. The most frequent location was the attic; significantly more locations were in the tympanic cavity with the CWU approach. These findings are important for surgeons and neuro-radiologists during follow-up.

Recurrent and persistent otitis media (OM) in childhood are characterized by prolonged and clinically different courses. The aim of this work is to study functional and morphological features in children with prolonged OM forms. Children with persistent OM with effusion and recurrent acute OM were examined by impedance audiometry, brainstem evoked response audiometry, registration of oto-acoustical emissions, pneumatic otoscopy, otomicroscopy, computer tomography and examination of surgical findings. Surgery consisted of modified version of tympanostomy. Otomicroscopical, cytological and histological examinations revealed the presence of morphological changes characteristic for chronic inflammation in part of recurrent and persistent OM. Duration of the process (more than 3 months) and previous treatment (physiotherapy and adenoidectomy) correlated with chronic changes in both groups. Prolonged OM forms present interrelated stages of the common inflammatory process in the middle ear. Functional changes, indicating the presence of OM for more than 3 months are the basis for comprehensive treatment, including tympanostomy. Modified tympanostomy permits better evacuation of pathological content from tympanic cavity and improves evaluation of morphological changes.

To determine the outcomes of using tragal cartilage in performing tympanoplasty. It was a prospective study of 57 patients with chronic suppurative otitis media. In all patients, pure tone audiometry was done pre-operatively. Tragal cartilage with attached perichondrium as graft material was used for ossicular chain reconstruction. In fifty out of the 57 participants, the outcome was intact ossicular chain. Of the 7 failures, 5 were recorded in the age group of 51–65 years, where graft uptake failed and hearing was not improved. Two of the failed cases required revision tympanoplasty. Post operative audiograms on follow-up revealed reduced air–bone gaps, with dry tympanic cavity and improved hearing. This study concluded that ossiculoplasty using tragal cartilage as a grafting material was an effective and safe surgical method for reconstruction of the ossicular chain and restoration of sound transmission.

Applying the principles of modern in situ tissue engineering, we developed a new regenerative treatment for tympanic membrane (TM) perforation using a combination of basic fibroblast growth factor (b-FGF), gelatin sponge, and fibrin glue, without the need for conventional surgical procedures or cell transplantation. Neither skin incisions nor the harvesting of autologous tissues is required to fully regenerate normal tympanic membrane (TM) morphology. With this technique, high success/cure rates and optimal hearing improvements are possible. Moreover, it can be performed within 20 min and is a simple, easy, and minimally invasive surgery. However, there are many cases in which it is difficult to visualize the entire TM perforation and tympanic cavity using a standard microscope. We thus attempted to apply this regeneration procedure to such cases using an endoscope and achieved a very high success rate for TM regeneration. This expands the application of endoscopic middle ear surgery to include TM regeneration.

The purpose of the current study is twofold. First, to investigate the variability of the petrotympanic fissure’s (PTF) morphology in anatomized human cadaveric specimens using multi-detector computed tomography (MDCT), and second, to compare the resulting measurements to investigate the possibilities of applying MDCT in the determination of PTF morphology in living humans. Specimens (n = 15) containing the temporal bone and TMJ were obtained from embalmed adult female (53.3%) and male (46.7%) cadavers and imaged using a helical 16-row scanner. Afterwards, cryosections were obtained and morphometric parameters were measured. Degree of agreement between both determinations was investigated and morphometric variables were also compared between PTF types. Three different types of PTF were identified. Type 1 was a wide tunnel-shaped structure. It was found in 20% of the cases. Type 2 was wide in the entrance but gradually narrows to the tympanic cavity. It was found in 46.7% of specimens. Finally, type 3, which was observed in 33.3% of the cases, was wide at the entrance of the mandibular fossa, followed by a middle region with flat-shaped tunnel structure and a narrow exit. The PTF’s vertical diameters at the mandibular fossa, midpoint, and tympanic cavity and the width at the mandibular fossa all were significantly greater in type 1 specimens. MDCT is suitable for investigating the variable morphology of human PTF and its association with middle ear’s and TMJ pathologies.

Objectives: We test the effects of body mass and phylogeny on middle ear cavity pneumatization, and the role of pneumatization in hearing function, spanning the anatomical, ecological, and behavioral diversity of nonhuman primates. Materials and methods: All cavities were segmented in middle ear scans of 96 specimens, from 12 strepsirrhine and 15 haplorhine extant species. We measured the tympanic cavity (TC) separately, and all other middle ear spaces together (MES), calculating the degree of pneumatization with the surface area-to-volume ratio. We tested body mass effect with linear regression; we evaluated the phylogenetic signal and selection patterns, using a Kappa statistic test, and Ornstein-Uhlenbeck models (OU). We investigated the link between pneumatization and hearing sensitivity using phylogenetic regression. Results: Testing body mass reveals an allometric pattern for both TC and MES dimensions. Degree of pneumatization in MES is dependent on body mass in haplorhines: larger animals have more pneumatized MES. Differences at various taxonomic ranks were observed for MES, while no phylogenetic influence was observed for TC. Infraorder selection patterns are different. Auditory performance is significantly related to degree of pneumatization, indicating that a pneumatized middle ear is associated with better perception of low frequencies. Discussion: Pneumatization in MES is under differential selective pressure, indicating several optima for this trait. Pneumatization in MES probably modifies hearing sensitivity through pressure regulation mechanisms, auditory bulla size reduction, and frequency modulation. This could explain strepsirrhine adaptation to high-frequency perception, while haplorhine auditory perception is adapted to a broader sound range, including high and low frequencies.

To evaluate clinical parameters, outcomes and complications of transcanal endoscopic ear surgeries (EES) and canal wall-up tympano-mastoidectomy (CWU) for middle ear cholesteatoma in children and to compare between the two surgical approaches. A retrospective chart review of all children (

To demonstrate the feasibility of robotic middle ear access in a clinical setting, nine adult patients with severe-to-profound hearing loss indicated for cochlear implantation were included in this clinical trial. A keyhole access tunnel to the tympanic cavity and targeting the round window was planned based on preoperatively acquired computed tomography image data and robotically drilled to the level of the facial recess. Intraoperative imaging was performed to confirm sufficient distance of the drilling trajectory to relevant anatomy. Robotic drilling continued toward the round window. The cochlear access was manually created by the surgeon. Electrode arrays were inserted through the keyhole tunnel under microscopic supervision via a tympanomeatal flap. All patients were successfully implanted with a cochlear implant. In 9 of 9 patients the robotic drilling was planned and performed to the level of the facial recess. In 3 patients, the procedure was reverted to a conventional approach for safety reasons. No change in facial nerve function compared to baseline measurements was observed. Robotic keyhole access for cochlear implantation is feasible. Further improvements to workflow complexity, duration of surgery, and usability including safety assessments are required to enable wider adoption of the procedure.

BACKGROUND Diagnosis and treatment strategies for CP with OME and the timing of ear tube insertion remain controversial. OBJECTIVES To analyze the clinical outcomes of otitis media with effusion in children with incomplete cleft palate after palatoplasty prospectively. METHODS A total of 30 children (10 months-2 years old) with incomplete CP were enrolled in this study and received at least 6 months of follow-up evaluations after palatoplasty. RESULTS The overall improvement rate of OME was as high as 26% in this group. Average air conduction hearing threshold was significantly better than that before surgery in the 8 patients with improved OME (p

Objectives Osteogenesis imperfecta (OI) is a systemic connective tissue disease that affects many systems and organs. Features of the disease are bone deformities, blue sclerae, and changes in the teeth, all of which may be accompanied by hearing loss. Bone fragility also affects structures of the ear, with half the patients developing changes in the auditory ossicles, which manifest as hearing loss. The most typical malformation affects the stapes, although the site of malformation within the middle ear varies. This study aims to characterize patients with OI who underwent surgery due to hearing loss and to find factors that affect the hearing results. Materials and methods This study presents an analysis of phenotypic and intraoperative changes among 20 patients with OI, treated surgically for hearing loss. Results Hearing loss typically affects type I patients with OI. The most common changes concern stapes footplate, arms, and tympanic cavity lining. During reoperations, osseous regrowth was typically detected. Conclusion The greater the changes induced systemically by OI, the greater the risk of significant malformations in the middle ear. Patients with OI are at an increased risk of needing revision surgery and of suffering intraoperative complications such as bleeding, which hinders safe completion of the procedure.

Inverted papilloma (IP) of the middle ear as a primary lesion or as an extension of a sinonasal papilloma, is extremely rare. Only 23 cases of primary inverted papilloma of the middle ear have been reported in the literature. They are locally aggressive tumours, with a high rate of recurrence and associated malignancy. We present a rare case of a 59-year-old man presenting with unilateral otorrhoea, tinnitus, and hearing loss. Otoscopy revealed posterior perforation filled by irregular budding neoformation. The temporal CT scan showed tissue filling the tympanic cavity as well as the mastoid antrum without bone lysis. The patient underwent limited tympanoplasty. An intraoperative biopsy of polypoid tissue filling the tymapanic cavity was made and histopathology showed an IP. A recurrence occurred 4 months after surgery. We performed open tympanoplasty allowing complete resection of the lesions, with no recurrence after a follow-up of 30 months.

Ostrich (Struthio camelus) is a species belonging to the Struthionidae family of Struthioniformes order that does not have the flying ability among birds. The aim of this study was to make a subgross investigation on anatomical structures of middle ear in ostrich and to determine the morphometry of the columella. In the present study, 4 adult ostrich heads were used in the study. Tympanic cavity and the formations inside are removed from the skull by protecting the cranial roof. Subgross examinations of tympanic cavity, columella and other anatomic structures were then performed, and morphometric measurements of columella and some anatomical structures were performed using a digital calliper.It was determined that tympanic cavity, surrounded by ear capsule (os oticum), had a conical shape and was covered with mucosa that was tightly adjacent to the periosteum. Tympanic membrane, columella and osteochondral structures, ligaments, a branch of external ophthalmic artery and the presence of chorda tympani were detected in tympanic cavity. It was observed that columella was placed diagonally in tympanic cavity. The vestibular (proximal) end having a circular shape was found to have a large basis and annular ligament which ended up with thickened, small columns. Finally, we demonstrated anatomy and morphometric values of middle ear in ostrich. The anatomy and formations of the middle ear are clearly shown. It can be asserted that anatomical formations in the middle ear of an ostrich are similar to other birds.

Objective The epithelium lining the human middle ear and adjacent temporal bone cavity shows a varying morphological appearance throughout these cavities. Its embryologic origin has long been debated and recently got attention in a newly proposed theory of a dual embryologic origin. The epithelial morphology and its differentiating capabilities are of significance in future mucosa-targeted therapeutic agents and could affect surgical approaches of the temporal bone. This study aims to analyze reported murine histological findings that led to the theory of a dual epithelial embryological origin and immunohistochemically investigate whether such an epithelial embryological origin in the human fetal middle ear could be true. Methods By combining a sagittal sectioning technique and immuno-histochemical staining, a comprehensive immuno-histological overview of the fetal human middle ear during a critical stage of tympanic cavitation was provided. A critical analysis of previously reported findings leading to the theory of a dual epithelial embryological origin and a comparison of these findings to the findings in the human fetal middle ear was performed. Results The reported findings and critical analysis provide multiple arguments for an entirely endodermal embryonic origin of the epithelium lining the tympanic cavity. Conclusion Different morphological epithelial appearances throughout the tympanic and temporal bone cavities could be explained by different stages of epithelial differentiation rather than different embryologic origin and endodermal rupture does not seem to be a necessity for these cavities to form.

Objective: The aim of this study is to perform a systematic literature review on the occurrence of gusher during stapes surgery, to understand its surgical management and outcomes. Methods: The PRISMA standard was applied to identify English, Italian or French-language studies, related to stapes surgery and mentioning gusher or perilymphatic leak. Full-texts lacking information on the management of gusher and/or the post-operative hearing outcome were excluded. Results: Twenty-four articles were eventually included. Seventy-six patients were involved in the qualitative synthesis. The management of gusher mostly consisted in covering the oval window and/or filling the tympanic cavity, with absorbable and autologous graft materials. Packing of the external auditory canal was reported in 51 patients (67%). Gusher was related to complete/profound loss of hearing in 25% of the cases and to a worsening of hearing function in 31% of patients. In 19% of patients an improvement in hearing tests was reported; in 28% the hearing function was unchanged. Post-operative vestibular symptoms were reported in 7 patients, and were mainly mild and transient. The absence of vestibular symptoms was underlined in 9 cases, while in 79% of the patients the authors did not provide information. Conclusion: The unexpected occurrence of gusher during stapes surgery represents a relevant issue for the otologic surgeon. Its management most commonly consists in plugging the oval window and the tympanic cavity. In most of the cases, a stapes prosthesis could be positioned. The results on hearing and vestibular functions are widely variable.

Background: In microscope assisted middle ear procedures surgeons can only observe the parts of the tympanic cavity, the hidden areas, such as the facial recess and sinus tympani, would not be visualised which needs to be exposed for performing tympanoplasty. The aim of the study was to compare the outcomes of microscope versus endoscope assisted myringoplasties in terms of duration of the procedure, graft take up, improvement in hearing and incidence of any complications.Methods: A prospective comparative study was conducted for a period of one year. A total of 72 patients with CSOM were randomised into two groups of 36 each. Group A patients (n=36) underwent traditional myringoplasty under a microscope and group B patients (n=36) endoscopic assisted myringoplasty was performed. Post-operatively all the patients were followed up for a period of one year. During the follow-up period patients were assessed for the graft take up, hearing improvement, incidence of complications and recurrence rate between the two groups.Results: Successful graft uptake was observed in 88.8% among patients underwent microscope assisted myringoplasty and it was 94.4% in endoscopic assisted myringoplasty. The mean duration of surgery was 123 mins in microscopic assisted group compared to 92 mins in endoscopic assisted group and the difference was found to be statistically significant. Similarly, the cosmetic results and the post-operative pain were more favorable for endoscopic assisted group than microscopic assisted group and the difference was found to be statistically significant.Conclusions: Enoscopic assisted procedure could be considered as a better alternative for microscopic assisted myringoplasty.

Objective To investigate the expression and correlation of vascular endothelial growth factor (VEGF) and its receptor with hypoxia-inducible factor-1 α (HIF-1 α) in otitis media with effusion (OME). Methods A rat model of OME was induced by injection of lipopolysaccharide (LPS) into the middle ear. Hematoxylin and eosin (HE) staining was used to observe the pathomorphological changes of the tympanic cavity in the middle ear of rats. Immunohistochemistry (IHC), western blotting and RT-qPCR were used to determine the mRNA and protein expression of VEGF, VEGFR-1, VEGFR-2 and HIF-1α in mucosa of tympanic cavity mucosa, respectively. Results In the OME group, the epithelial space of the middle ear mucosa was significantly thickened and infiltration of a large number of inflammatory cells was found on postoperative day (POD), and the otitis media basically subsided 2 weeks after operation. VEGF mRNA expression was significantly increased on POD 1, and its protein expression peaked on POD 3. HIF-1α mRNA expression was significantly increased and peaked on POD 1, while its protein expression began to increase on POD 3 and was significantly expressed in the middle ear mucosal epithelium. HIF-1α mRNA showed a positive correlation with VEGF mRNA and VEGFR-1 mRNA expression. Conclusion VEGF mainly plays a role in the acute phase of OME, and it is abundantly expressed mediated by HIF-1α. And then it play a role in vasodilatation and increase of vascular permeability, thus promoting the generation of middle ear effusion.

Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope. Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis (n = 30) or chronic otitis media (n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope—VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope. Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope. Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.

Objective: The primary goal in the surgical management of chronic otitis media with cholesteatoma is the creation of a dry and safe ear. The method of choice for management of cholesteatoma is the inside out or reverse mastoidectomy. If external auditory canal reconstruction after complete cholesteatoma removal is not possible, mastoid cavity obliteration techniques are recommended to reduce the size of the open mastoid cavity. The goal of our study is to evaluate the frequency of postoperative ear secretion and hearing situation in patients with mastoid cavity obliteration in treatment of middle ear cholesteatoma. Methods: Retrospective study of 155 patients with middle ear cholesteatoma were surgically treatment during 52 months from 01.06.2014 to 30.09.2018 in Hospital Trakia Park, Stara Zagora (Bulgaria) with canal wall reconstruction or mastoid cavity obliteration with cartilage, bone pate or bone replacement alloplastic materials. Results: After complete cholesteatoma removal we perform ear canal reconstruction in 51.61% of cases (80; n=155), and in others 41.94% of cases (65; n=155) we perform mastoid cavity obliteration. In our patient group we perform type I tympanoplasty in 36.77% (57; n=155), type III tympanoplasty in 46.45% (72; n=155), Secondlook operations in 14% (21, n = 155) and only in 5 cases we left the operating cavity open (3.23%; n=155). After mean follow-up period from 11.34 months (1÷48 months; SD 13.10 months) our frequency of postoperative ear secretion is 6.45% (10; n=155) and our cholesteatoma residual rate is 9.03% (14; n=155). Conclusion: Mastoid cavity obliteration procedures can prevent the development of postoperative retraction pockets by isolation the tympanic cavity from the attic and mastoid. This is a safe and effective technique for rehabilitation of mastoid cavities. Hearing results of this technique is variable according to the involvement of the middle ear ossicles, but with the possibility of fitting a hearing aids or middle ear implants.

Eustachian tube dysfunction is believed to be an important factor to cholesteatoma development and recurrence of disease after surgical treatment. Although many studies have described prognostic factors, evaluation methods, or surgical techniques for Eustachian tube dysfunction, they relied on the soft tissues of its structure; little is known about its bony structure-the protympanum-which connects the Eustachian tube to the tympanic cavity, and can also be affected by several inflammatory conditions, both from the middle ear or from the nasopharynx. We studied temporal bones from patients with cholesteatoma, chronic otitis media (with and without retraction pockets), purulent otitis media, and non-diseased ears, looking for differences between the volume of the protympanum, the diameter of the Eustachian tube isthmus, and the distance between the anterior tympanic annulus and the promontory. Light microscopy and 3-D reconstruction software were used for the measurements. We observed a decrease of volume in the lumen of the four middle ear diseased ears compared to the control group. We observed a significant decrease in the volume of the protympanic space in the cholesteatoma group compared to the chronic otitis media group. We also observed a decrease in the bony space (protympanum space) in cholesteatoma, chronic otitis media with retraction pockets, and purulent otitis media compared to the control group. We found a correlation in middle ear diseases and a decrease in the middle ear space. Our findings may suggest that a smaller bony volume in the protympanic area may trigger middle ear dysventilation problems.

The middle ear is a sophisticated and complex structure with a variety of functions, yet a delicate organ prone to injuries due to various reasons. Both, understanding and reconstructing its functions has always been an important topic for researchers from medical and technical background. Currently, human temporal bones are generally used as model for tests, experiments and validation of the numerical results. However, fresh human preparations are not always easily accessible and their mechanical properties vary with time and between individuals. Therefore we have built an anatomically based and functional middle ear model to serve as a reproducible test environment. Our middle ear model was manufactured with the aid of 3D-printing technology. We have segmented the essential functional elements from micro computed tomography data (μCT) of a single temporal bone. The ossicles were 3D-printed by selective laser melting (SLM) and the soft tissues were casted with silicone rubber into 3D-printed molds. The ear canal, the tympanic cavity and the inner ear were artificially designed, but their design ensured the anatomically correct position of the tympanic membrane, ossicular ligaments and the oval window. For the determination of their auditory properties we have conducted two kinds of tests: measurement of the stapes footplate response to sound and tympanometry of the model. Our experiments regarding the sound transmission showed that the model has a similar behavior to a human middle ear. The transfer function has a resonance frequency at around 1 kHz, the stapes' response is almost constant for frequencies below the resonance and a roll-off is observed above the resonance. The tympanometry results show that the compliance of the middle ear model is similar to the compliance of a healthy human middle ear. We also present that we were able to manipulate the transmission behavior, so that healthy or pathological scenarios can be created. For this purpose we have built models with different mechanical properties by varying the hardness of the silicone rubber used for different structures, such as tympanic membrane, oval window and ossicle attachments in the range of Shore 10–40 A. This allowed us to set the transmission amplitudes in the plateau region higher, lower or within the tolerances of normal middle ears (Rosowski et al., 2007). Our results showed that it is possible to build an artificial model of the human middle ear by using 3D-printing technology in combination with silicone rubber molding. We were able to reproduce the anatomical shape of the middle ear's essential elements with high accuracy and also assemble them into a functioning middle ear model. The acoustic behavior of the model can be reproduced and manipulated by the choice of material. If the issues such as resonance of the casing and steep roll-off slope in higher frequencies can be solved, this model creates a reproducible environment for experiments and can be useful for the evaluation of prosthetic devices.

The fibrocartilaginous eustachian tube is part of a system of contiguous organs including the nose, palate, rhinopharynx, and middle ear cleft. The middle ear cleft consists of the tympanic cavity, which includes the bony eustachian tube (protympanum) and the mastoid gas cells system. The tympanic cavity and mastoid gas cells are interconnected and allow gaseous exchange and pressure regulation. The fibrocartilaginous eustachian tube is a complex organ consisting of a dynamic conduit with its mucosa, cartilage, surrounding soft tissue, peritubal muscles (ie, tensor and levator veli palatine, salpingopharyngeus and tensor tympani), and superior bony support (the sphenoid sulcus).

Paralleling the introduction of endoscopes for sinus surgery more than two decades ago, otology is facing a similar paradigm shift in the use of endoscopes to perform ear surgery. The wide-angle and high-resolution image provided by endoscopes allows for improved visualization of the tympanic cavity using minimally invasive surgical portals. Incorporating endoscopic ear surgery into otologic practice is challenging. A graduated and step-wise introduction of EES to otologic surgery is recommended to ensure safe and successful implementation.

The ear is one of the most complex organs in the human body. Sound is a sequence of pressure waves, which propagates through a compressible media such as air. The pinna concentrates the sound waves into the external auditory meatus. In this canal, the sound is conducted to the tympanic membrane. The tympanic membrane transforms the pressure variations into mechanical displacements, which are then transmitted to the ossicles. The vibration of the stapes footplate creates pressure waves in the fluid inside the cochlea; these pressure waves stimulate the hair cells, generating electrical signals which are sent to the brain through the cochlear nerve, where they are decoded. In this work, a three-dimensional finite element model of the human ear is developed. The model incorporates the tympanic membrane, ossicular bones, part of temporal bone (external auditory meatus and tympanic cavity), middle ear ligaments and tendons, cochlear fluid, skin, ear cartilage, jaw and the air in external auditory meatus and tympanic cavity. Using the finite element method, the magnitude and the phase angle of the umbo and stapes footplate displacement are calculated. Two slightly different models are used: one model takes into consideration the presence of air in the external auditory meatus while the other does not. The middle ear sound transfer function is determined for a stimulus of 60 dB SPL, applied to the outer surface of the air in the external auditory meatus. The obtained results are compared with previously published data in the literature. This study highlights the importance of external auditory meatus in the sound transmission. The pressure gain is calculated for the external auditory meatus.

Objectives To describe objective tinnitus complicated with transient low-tone hearing loss coinciding with mouth opening, which was related to the connection between the mandibular fossa and middle ear space. Patients A 41-year-old man presented with tinnitus, ear fullness, and hearing loss in the left ear on mouth opening. Main outcome measures Clinical case records, audiological data, and radiological analyses including computed tomography (CT) and magnetic resonance imaging. Results Hearing thresholds on the affected side, which were evaluated with mouth opening, showed elevations of approximately 20 dB in the frequencies below 1000 Hz. Again, peak pressure on the tympanogram deviated negatively to -220 mmH2O under mouth opening without changing peak amplitude. CT showed a connection between the mandibular fossa and middle ear space, as revealed by a gas collection around the joint capsule evaluated in two phases (with and without mouth closing). Ear symptoms resolved after myringotomy. Conclusions Although an influence of temporomandibular disorder (TMD) on tinnitus perception has been debated, whether this association is causal or fortuitous has remained contentious. The present case showed a unique feature of tinnitus attributed to a connection between the mandibular fossa and middle ear space.

Feline inflammatory polyps are the most common nonneoplastic lesion of ear and nasopharynx in cats. Minimally invasive techniques for polyp removal, such as traction avulsion combined with curettage of the tympanic cavity and per-endoscopic transtympanic traction, have been successful for long-term resolution. Feline nasal hamartomas are benign lesions of the nasopharynx, and most have a good prognosis after surgical removal. Canine aural and nasopharyngeal inflammatory polyps are rare and have a similar clinical presentation as cats with these lesions. In dogs, it is important to achieve an accurate histologic diagnosis of these masses before appropriate surgical treatment can be planned.

Cholesteatoma is a progressive destructive ear disease which can affect any age group. It has been found to be more severe in children and young adults. It erodes the surrounding bone of middle ear, mastoid and ossicles. It causes partial to total deafness, unpleasant smelling discharge, pain, tinnitus, vertigo and facial paralysis. It can even cause meningitis, brain abscess and death. The post-operative outcome of hearing, and the state of the reconstructed middle-ear cavity after concurrent and staged reconstruction of middle ear after canal wall down mastoidectomy was studied in 30 ears with middle-ear cholesteatoma. The reconstructed middle ear was re-aerated in 60.5 % of the cases, which was significantly higher than for the epitympanum (39.5 %). Tympanoplasty was successful in terms of hearing results in 68.9 % of all subjects and in 75.4 % of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 % for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p

Tympanic paragangliomas (TP) arise in the middle ear along the course of Jacobson׳s or Arnold׳s nerve. These lesions can vary from small masses on the cochlear promontory to tumors that extend into the mastoid and external auditory canal. Surgical excision is the treatment of choice for TP with very low-recurrence rates. The various surgical approaches for TP are adapted to the configuration of individual tumors to provide adequate exposure to the margins of the tumor in the mesotympanum, hypotympanum, and mastoid. Using these surgical approaches in combination with meticulous dissection and hemostasis with adjunctive tools such as laser and micro-bipolar instruments allows for safe and effective resection of these vascular tumors from within the confines of the tympanic cavity.

Aim of this study was to induce a single-sided deafness (SSD) in rats before hearing onset. Rats were operated at postnatal day 10 by approaching the tympanic cavity along a retroauricular path without manipulating ossicles or tympanic membrane. The ototoxic aminoglycoside neomycin was injected intracochlearly through the round window membrane on one side. When the animals have reached young adult stages, their hearing threshold was determined by their auditory brainstem response (ABR). Monaural deafening was considered successful when the hearing threshold was at least 95 dB above the threshold of the normal hearing ear. Growing up with one non-functional ear, rats developed a striking anatomical asymmetry of their cochlear nuclei (CN). The CN from age-matched normal hearing brains and from both sides of single-sided deaf brains were cut into series of frontal sections and their volumes calculated. No difference was detected between the volume of the normal hearing CN and the contralateral CN in SSD rats. By contrast, growth retardation was found for the ventral CN on the deaf side to result in a volume of only 57% compared to the normal hearing side. Marginal growth retardation was also observed for the dorsal CN on the deaf side. Thus, loss of sensory activation leads mainly, but not exclusively, to a reduction of tissue volume in the ventral CN of the deaf side, leaving the contralateral side apparently unaffected.

Prevalence of subclinical middle ear lesions in dogs that undergo computed tomography (CT) and magnetic resonance imaging of the head has been reported up to 41%. A predisposition in brachycephalics has been suggested, however evidence-based studies are lacking. Aims of this retrospective cross-sectional study were to compare CT characteristics of the middle ear in groups of nonbrachycephalic and brachycephalic dogs that underwent CT of the head for conditions unrelated to ear disease, and test associations between thickness of the soft palate and presence of subclinical middle ear lesions. One observer recorded CT findings for each dog without knowledge of group status. A total of 65 dogs met inclusion criteria (25 brachycephalic, 40 nonbrachycephalic). Brachycephalic dogs had a significantly thicker bulla wall (P = 2.38 × 10(-26)) and smaller luminal volume (P = 5.74 × 10(-20)), when compared to nonbrachycephalic dogs. Soft palate thickness was significantly greater in the brachycephalic group (P = 2.76 × 10(-9)). Nine of 25 brachycephalic dogs had material in the lumen of the tympanic cavity, compared to zero of 45 of nonbrachycephalics. Within the brachycephalic group, a significant difference in mean soft palate thickness was identified for dogs with material in the middle ear (12.2 mm) vs. air-filled bullae (9 mm; P = 0.016). Findings from the current study supported previous theories that brachycephalic dogs have a greater prevalence of subclinical middle ear effusion and smaller bulla luminal size than nonbrachycephalic dogs. Authors recommend that the bulla lumen volume formula previously developed for mesaticephalic dogs, (-0.612 + 0.757 [lnBW]) be adjusted to 1/3(-0.612 + 0.757 [lnBW]) for brachycephalic breeds.

In postcontrast computed tomographic (CT) images, feline nasopharyngeal polyps typically demonstrate enhancement of the peripheral rim. Computed tomographic images and histologic specimens of a case series of 22 cats with surgically removed nasopharyngeal polyps were reviewed retrospectively in an attempt to elucidate the origin of rim enhancement. Polyps were present in the tympanic cavity in 15 (68%) cats (three with extension into the nasopharynx), only in the nasopharynx in four (18%) cats, and only in the external ear canal in the remaining three (14%) cats. All polyps had variable degrees of epithelial injury. Hemorrhage and inflammatory infiltration were significantly more marked in the superficial stroma whereas edema was significantly more marked in the core stroma. In noncontrast CT images (n = 22), the tympanic bulla was thickened in all 15 cats with a polyp in the tympanic cavity and enlarged in eight (53%) of these cats. In postcontrast CT images (n = 15), an outer zone of relatively increased attenuation compatible with a rim was observed in 11 (73%) polyps. The magnitude and extent of rim enhancement in CT images was positively correlated with the histologic grade of inflammation in the superficial stroma and negatively correlated with the grade of edema in the superficial stroma. It appears that inflammation is the major determinant of contrast medium accumulation in feline nasopharyngeal polyps, and the tendency for inflammation to affect predominantly the superficial layers explains the frequent observation of a rim in postcontrast CT images.

Background: To identify predictors for development of mastoiditis after intensity-modulated radiation therapy (IMRT) in nasopharyngeal carcinoma (NPC). Methods: Data for 146 NPC patients treated with IMRT was retrospectively reviewed under institutional ethics committee approval. Clinical factors associated with mastoiditis were analyzed. Dose-volume histogram analysis was performed for the Eustachian tube, tympanic cavity, mastoid air cells, cochlea, internal auditory canal and vestibular apparatus to relate doses to radiographic changes in the mastoid. Mastoiditis was assessed using magnetic resonance imaging and was classified as Grade 0 (none), 1 (mild), 2 (moderate) or 3 (severe); Grade 3 mastoiditis was the study end-point. Results: Eighty-eight ears (36%) had radiation-induced mastoiditis: 38/244 (15.6%) mastoid complexes had Grade 1-2 mastoiditis and 50/244 (20.5%) mastoid complexes had Grade 3 mastoiditis. Multivariate analysis revealed a mastoid mean dose > 35.93 Gy (odds ratio [OR]=4.22, P=.003), Eustachian tube mean dose > 53.43 Gy (OR=2.16, P=.034) and advanced T category (T3 and T4; OR=10.33, P=.032) were negative prognostic factors for Grade 3 mastoiditis. Conclusions: Radiation-induced mastoiditis remains a common late toxicity in NPC after radiotherapy. The mean dose to the mastoid air cells and Eustachian tube should be limited to reduce the risk of radiation-induced mastoiditis.

Introduction. The surgical operations on the middle ear in premature infants require precise knowledge of anatomical and topographical characteristics of the temporal bone structure. Objective. To explore topographic-anatomical characteristics of the middle ear in the 9-month fetuses during their antenatal development and to prove morphological interrelationships of the form-building processes with surrounding structures. Materials and methods. The research was conducted on 7 human fetuses with 311.0–345.0 7-mm parietal-coccygeal length. The methods of the fine dissection of middle ear and the surrounding areas under the control of binocular loupe; macro- and microscopy; morphometry; macrophotografies using the digital camera OLIMPUS μ 1000 All-weather 10.0 MPix were used within the study. Results and discussion. The tympanic cavity of the 9-month human fetuses during the antenatal development obtains more irregular shape, the numerous cells appear on its walls, the inferior and anterior walls of the tympanic cavity as well as the attic continue their formation, the tympanic openings of auditory tubes begin to move from the bottom of the tympanic cavity upward. Conclusions. The inferior and anterior walls of the tympanic cavity as well as the attic of the human fetuses during their 9-month antenatal development continue their formation. The tympanic openings of the auditory tubes begin to move from the bottom of the tympanic cavity upward. The determined peculiarities of tympanic cavity structure in the 9-month human fetus are essential to the improvement of technologies and the performance of surgical treatment and manipulations in premature neonates.

We report a unique case of unilateral presentation of vestibular schwannoma and cholesteatoma. A 62 year old male presented with deafness of the left ear and mixed-hearing loss in the right ear. The CT examination revealed extensive cholesteatoma in the tympanic cavity with fistula of the lateral semicircular canal and erosions of the cochlea. The MRI examination additionally showed the presence of a tumor in the cerebello-pontine angle on the left side. Cholesteatoma and the tumor were removed simultaneously with transotic approach. The postoperative period was complicated with cerebrospinal fluid otorrhea, which was managed without the need of reoperation. During 2,5 year of follow-up there were no other complications connected with the treatment. Unilateral presentation of vestibular schwannoma and cholesteatoma has to be included into the differential diagnosis of temporal bone pathology. Transotic approach enables safe removal of combined pathology of the temporal bone.

Otitis media with effusion (OME) accounts for 15-17% of the total number of recorded diseases of the middle ear. Surgical methods have become much more common. One of the factors affecting the tactics and effectiveness of treatment OME is the degree of viscosity of the effusion. Modern diagnostic methods do not allow to reliably identify cases of OME with high effusion viscosity.To study the possibilities of optical coherence tomography (OCT) in the diagnosis of OME and a non-invasive study of effusion viscosity.An analysis of the results of the examination of 29 patients who underwent surgical treatment for OME - tympanostomy. A control group of 30 patients without middle ear pathology. The study used a spectral OCT with a non-contact probe designed specifically for studies of the structural middle ear. Quantitative analysis of the results using open source ImageJ. Objectification of the degree of viscosity of the effusion was carried out by means of viscometry. A comparative analysis of the intensity of the optical signal in the external auditory canal (EAC) and in the tympanic cavity (TC) was performed, as well as a comparison of the signal from viscous and fluid effusion.In all patients with OME, during the OCT study, an optical signal with a higher intensity was recorded in TC than in the EAC. In all cases, in the control group in the TC, an optical signal was recorded that was identical in intensity with the signal in the EAC. When measuring the degree of viscosity of the effusion, 17 cases of OME were characterized as effusion of a low degree of viscosity, 12 cases - effusion of extreme viscosity. When comparing the average intensity of the optical signal of the OCT images of viscous and liquid effusion, a statistically significant difference was revealed,OCT makes it possible to detect light scattering from large scatterers - cell structures characteristic of low viscosity effusion. In addition, OCT allows you to register an optical signal from small scatterers - high molecular weight structures that are present in large quantities in viscous effusion. A correlation was found between the intensity of the optical signal in the TC and the degree of viscosity of the middle ear effusion.Based on OCT data, it is possible to determine the indications for surgical treatment of OME by detecting viscous exudate.Экссудативный средний отит (ЭСО) занимает 15—17% от общего количества регистрируемых заболеваний среднего уха. В течение последних десятилетий изменились подходы к лечению ЭСО, хирургические методы стали применяться значительно чаще. Одним из факторов, влияющих на тактику и эффективность лечения ЭСО, является степень вязкости экссудата. Современная комплексная диагностика не позволяет достоверно выявить случаи ЭСО с высокой вязкостью выпота.Изучение возможностей оптической когерентной томографии (ОКТ) в диагностике ЭСО и неинвазивном определении вязкости экссудата.Проведен анализ результатов обследования 29 пациентов, которым было проведено хирургическое лечение по поводу ЭСО — тимпаностомия. Контрольную группу составили 30 пациентов без патологии среднего уха. В исследовании использовалась спектральная ОКТ с бесконтактным зондом, разработанным специально для исследования структур среднего уха. Количественный анализ полученных ОКТ-изображений производился с помощью программного обеспечения с открытым кодом ImageJ. Объективизация степени вязкости экссудата осуществлялась путем проведения вискозиметрии. Был проведен сравнительный анализ интенсивности оптического сигнала в наружном слуховом проходе (НСП) и в барабанной полости (БП), а также сравнение сигнала от вязкого и жидкого экссудата.У всех пациентов с ЭСО при ОКТ-исследовании в БП регистрировался оптический сигнал большей интенсивности, чем в НСП. Во всех случаях в контрольной группе в зоне БП был зарегистрирован оптический сигнал, идентичный по интенсивности сигналу в НСП. При измерении степени вязкости экссудата 17 случаев ЭСО были охарактеризованы как выпот низкой степени вязкости, 12 образцов — как экссудат крайней степени вязкости. При сравнении величины средней интенсивности оптического сигнала ОКТ-изображений вязкого и жидкого экссудата было выявлено статистически сверхзначимое различие,ОКТ позволяет регистрировать рассеяние света от крупных рассеивателей — клеточных структур, характерных для выпота низкой степени вязкости. Кроме того, ОКТ позволяет регистрировать оптический сигнал от мелких рассеивателей — высокомолекулярных структур, которые присутствуют в большом количестве в вязком экссудате. Выявлена корреляция между интенсивностью оптического сигнала в БП и степенью вязкости выпота среднего уха.На основании данных ОКТ возможно определение показаний к хирургическому лечению ЭСО путем выявления вязкого экссудата.

Modern methods for diagnosis of exudative otitis media (EOM) have great potential, however, the problem of diagnosis of EOM is still relevant. The article describes the methods of modern diagnostics that are widely used in the daily practice of an otolaryngologist. The basic principles, advantages and disadvantages of generally accepted diagnostic methods for EOM are presented. The method of optical coherence tomography (OCT) is described as a method of studying biological tissues, which is used in many fields of medicine. Information is provided on the possibilities of OCT in the diagnosis of diseases of the ENT organs and, in particular, of the middle ear. The results of studies of the tympanic cavity structures in various inflammatory conditions, the possibilities of intrasurgery use of OCT, as well as the possibilities and perspectives of introducing OCT into the practice of an otorhinolaryngologist in the diagnosis of exudative otitis media are described.Современные методы диагностики экссудативного среднего отита (ЭСО) обладают широкими возможностями, однако проблема диагностики ЭСО все еще актуальна. В работе описаны методы современной диагностики, получившие широкое распространение в ежедневной практике оториноларинголога. Представлены основные принципы, преимущества и недостатки общепринятых методов диагностики ЭСО. Метод оптической когерентной томографии (ОКТ) описан как метод исследования биологических тканей, применяющийся во многих сферах медицины. Представлена информация о возможностях ОКТ в диагностике заболеваний лор-органов, в частности среднего уха. Описаны результаты исследований структур барабанной полости при различных воспалительных состояниях, возможности интраоперационного использования ОКТ, а также возможности и перспективы внедрения ОКТ в практику оториноларинголога при диагностике экссудативного среднего отита.

We used a surgical procedure suggested by Murata et al. and inserted a T-silicon plate from the tympanic cavity into the opening of the eustachian tube in 2 cases of chronic otitis media. The goal of this surgery was to promote the regeneration and the epithelization of residual mucosa of the eustachian tube. In our results, epitheliums of regenerated tympanic mucosa were histologically examined.

Identification of perpetuating factors, such as otitis media (OM), is important for the successful management of canine chronic otitis externa (OE).Occult OM can occur in cases of chronic OE; a focused magnetic resonance imaging (MRI) examination is a useful tool in their management.One hundred twenty one client-owned dogs presented for investigation and treatment of chronic OE between 2009 and 2018.Mixed retrospective (74 dogs) and prospective (47 dogs) study of chronic OE cases without neurological signs, describing the MRI, otoscopic and cytological findings; comparing cases with and without MRI evidence of OM.A total of 123 MRI studies were analysed (two dogs scanned twice). A short, focused MRI scan allowed detection of inflammation of the mucosal bulla lining as well as excellent discrimination between avascular material and vascularised soft tissue in the tympanic cavity. OM was found in 41 of 197 (21%) ears with chronic otitis externa. On otoscopy, the tympanic membrane was intact in six of 41 ears (15%), ruptured in 16 of 41 (39%) and not visible in 14 of 41 (34%) [no data in five of 41 (12%)]. Analysis of cytological findings showed that the presence of rods was only associated with an increased likelihood of OM when found together with inflammatory cells.Occult OM is a not uncommon finding on MRI of dogs with chronic OE. A targeted MRI study ("bulla mini-scan") may be useful as part of the clinical investigations.L'identification de facteurs perpétuant, tels que l'otite moyenne (OM), est important pour la gestion efficace d'otite chronique externe (OE). HYPOTHÈSES/OBJECTIFS: Une OM occulte peut se développer dans les cas d’OE chroniques; un examen d'imagerie par résonance magnétique (MRI) est un outil utile pour la gestion.Cent-vingt-et-un chiens de propriétaires présentés pour investigation et traitement d’OE chronique entre 2009 et 2018. MATÉRIEL ET MÉTHODE: Une étude mixte rétrospective (74 chiens) et prospective (47 chiens) de cas d’OE chroniques sans signe neurologique, décrivant les IRM, les données otoscopiques et cytologiques; comparaison de cas avec et sans preuve d’OM par IRM. RÉSULTATS: Un total de 123 études d’IRM a été analysé (deux chiens scannés deux fois). Un IRM court et ciblé permet la détection de l'inflammation de la muqueuse tapissant la bulle ainsi qu'une excellente discrimination entre le matériel avasculaire et les tissus mous vascularisés de la cavité tympanique. L’OM a été trouvée pour 41 des 197 (21%) oreilles avec otite externe chronique. A l'otoscopie, la membrane tympanique était intacte pour six des 41 oreilles (15%), rompue dans 16 des 41 (39%) et non visible dans 14 des 41 cas (34%) [pas de donnée pour cinq des 41 (12%)]. Les analyses des données cytologiques ont montré que la présence de bacilles était seulement associée avec une augmentation marquée de l’OM quand trouvée associée avec des cellules inflammatoires.Une OM occulte n'est pas rare à l’IRM pour les chiens atteints d’OE chronique. Une étude ciblée sur les IRM (“bulla mini-scan”) peut être utile en tant que part des investigations cliniques.INTRODUCCIÓN: la identificación de factores perpetuantes, como la otitis media (OM), es importante para el manejo adecuado de la otitis externa crónica (OE) canina. HIPÓTESIS/OBJETIVOS: La OM oculta puede ocurrir en casos de OE crónica; un examen por resonancia magnética focalizada (MRI) es una herramienta útil en su manejo. ANIMALES: ciento veintiún perros de propietarios particulares se presentaron para investigación y tratamiento de OE crónica entre 2009 y 2018. MÉTODOS Y MATERIALES: estudio mixto retrospectivo (74 perros) y prospectivo (47 perros) de casos crónicos de OE sin signos neurológicos, que describe la MRI, los hallazgos otoscópicos y citológicos; comparando casos con y sin evidencia de OM en la resonancia magnética. RESULTADOS: se analizaron un total de 123 estudios de resonancia magnética (dos perros escaneados dos veces). Una resonancia magnética corta y focalizada permitió detectar la inflamación del revestimiento de la mucosa de la bulla, así como una excelente discriminación entre el material avascular y el tejido blando vascularizado en la cavidad timpánica. Se encontró OM en 41 de 197 (21%) oídos con otitis externa crónica. En la otoscopia, la membrana timpánica estaba intacta en seis de 41 oídos (15%), se rompió en 16 de 41 (39%) y no era visible en 14 de 41 (34%) [sin datos en cinco de 41 (12%)] . El análisis de los hallazgos citológicos mostró que la presencia de bacilos solo se asoció con una mayor probabilidad de OM cuando se encontraron junto con células inflamatorias. CONCLUSIONES E IMPORTANCIA CLÍNICA: la OM oculta es un hallazgo relativamente frecuente en MRI de perros con OE crónica. Un estudio de resonancia magnética dirigido (“mini-scan de la bulla”) puede ser útil como parte de las investigaciones clínicas.Die Identifizierung von perpetuierenden Faktoren, wie eine Otitis media (OM), sind wichtig für ein erfolgreiches Management einer chronischen Otitis externa des Hundes (OE).Eine okkulte OM kann in Fällen chronischer OE auftreten; für ein erfolgreiches Management ist eine fokusierte Magnetresonanzuntersuchung (MRI) ein nützliches Werkzeug.Einhunderteinundzwanzig Hunde in Privatbesitz wurden zur Untersuchung und Behandlung einer chronischen OE zwischen 2009 und 2018 vorgestellt.Eine gemischte retrospektive (74 Hunde) und prospektive (47 Hunde) Studie von Fällen mit chronischer OE ohne neurologische Zeichen; eine Beschreibung des MRI, otoskopischer und zytologischer Befunde; sowie ein Vergleich der Fälle mit und ohne MRI Evidenz einer OM.Insgesamt wurden 123 MRI Studien analysiert (zwei Hunde wurden zweimal gescannt). Ein kurzer, fokusierter MRI Scan ermöglichte das Erkennen einer Entzündung der Mucosa der Bulla sowie eine ausgezeichnete Unterscheidung zwischen avaskulärem Material und vaskularisiertem Weichteilgewebe in der Paukenhöhle. Eine OM wurde bei 41 der 197 (21%) Ohren mit chronischer Otitis externa festgestellt. Otoskopisch war das Trommelfell bei sechs der 41 Ohren (15%) intakt, bei 16 der 41 (39%) rupturiert und bei 14 der 41 (34%) unsichtbar [es gibt bei fünf von 41 (12%) keine Daten]. Eine Analyse der zytologischen Daten zeigte, dass das Vorkommen von Stäbchen nur mit einer erhöhten Wahrscheinlichkeit einer OM assoziiert werden konnte, wenn sie zusammen mit Entzündungszellen gefunden wurden.Eine okkulte OM ist kein seltener Befund am MRI von Hunden mit chronischer OE. Eine gezielte MRI Studie („Bulla Mini-Scan“) könnte als Teil der klinischen Untersuchungen nützlich sein.背景: 犬の慢性外耳炎(OE)の管理を成功させるためには中耳炎(OM)のような永続的要因の特定が重要である。 仮説/目的: オカルトOMは慢性OEの場合に発生する可能性がある。集中磁気共鳴画像法(MRI)検査は、その管理に役立つツールである。 被験動物: 2009年から2018年の間に慢性OEの調査および治療のために来院した飼育犬121頭。 材料と方法: 本研究は神経学的徴候のない慢性OE症例の回顧的(74頭)および前向き(47頭)混合研究で、MRI検査、耳鏡検査および細胞学的所見について説明する。 また、MRI検査により確定したOMの有無による症例の比較を説明する。 結果: 計123件のMRI研究を解析した(2頭の犬に関しては2回スキャンした)。短焦点MRIスキャン法により、粘膜鼓室胞の炎症の検出および鼓膜腔内の無血管物質および血管化軟組織との優れた識別が可能になった。 OMは、慢性外耳炎を伴う197耳中41耳(21%)で検出された。耳鏡検査では、鼓膜は41耳のうち6耳(15%)で無傷で、41耳のうち16耳(39%)で破裂し、41耳のうち14耳(34%)で可視化できなかった[データなし41耳5耳(12%)] 。細胞学的所見解析により、桿菌が炎症細胞と一緒に発見された場合のみ、OMの可能性の増加と関連することが示された。 結論と臨床的重要性: オカルトOMは、慢性OE犬のMRI検査においては珍しい所見ではない。対象を絞ったMRI研究(「bulla mini-scan」)は、臨床調査の一環として役立つ可能性がある。.背景: 确定是否存在像中耳炎(OM)这样的持久病因,对犬慢性外耳炎(OE)的成功治疗很重要。 假设/目标: 慢性OE患犬可出现隐性OM; 在对其管理上,磁共振成像(MRI) 聚焦检查是一种有用的工具。 动物: 在2009年至2018年间,121只家养犬因慢性OE接受调查和治疗。 方法和材料: 对无神经症状的慢性OE病例进行回顾性(74只犬)和前瞻性(47只犬)混合研究,报告MRI、耳镜和细胞学检查结果;比较有和没有MRI证明的OM病例。 结果: 共分析了123例MRI研究(2只犬扫描两次)。MRI短的聚焦扫描可以检测到鼓泡内膜的黏膜炎症,并能很好分辨鼓室内的无血管物质和血管化软组织。在197只慢性外耳炎患犬中,有41只(21%)发现OM。在耳镜检查中,41只耳道中有6只(15%)鼓膜完整,16只(39%)鼓膜破裂,14只(34%)鼓膜不可见[有5只(12%)没有数据]。细胞学分析结果显示,当杆菌与炎症细胞一起出现时,OM的可能性增加。 结论和临床意义: 在慢性OE犬身上,MRI发现隐性OM的情况并不少见,靶向MRI研究(“鼓泡微扫描”)对部分临床检查可能有意义。.A identificação de fatores perpetuadores, como a otite média (OM), é importante para o manejo bem-sucedido da otite externa (OE) crônica canina. HIPÓTESE/OBJETIVOS: A OM oculta pode ocorrer em casos de OE crônica; um exame de ressonância magnética (RM) focalizada é uma ferramenta útil em seu manejo.Cento e vinte e um cães pertencentes a clientes apresentados para investigação e tratamento de OE crônica entre 2009 e 2018. MÉTODOS E MATERIAIS: Estudo retrospectivo (74 cães) e prospectivo (47 cães) de casos crônicos de OE sem sinais neurológicos, descrevendo os achados de ressonância magnética, achados citológicos e otoscópicos; comparando casos com e sem evidência de OM na RM.Foram analisados ​​123 estudos de ressonância magnética (dois cães examinados duas vezes). Ressonância magnética curta e focada permitiu a detecção de inflamação do revestimento mucoso da bula, além de uma excelente discriminação entre material avascular e tecido mole vascularizado na cavidade timpânica. Encontrou-se OM em 41 de 197 (21%) ouvidos com otite externa crônica. À otoscopia, a membrana timpânica estava intacta em seis das 41 orelhas (15%), rompida em 16 das 41 (39%) e não visível em 14 das 41 (34%) [não há dados em cinco das 41 (12%)]. A análise dos achados citológicos mostrou que a presença de bastonetes estava apenas associada a uma maior probabilidade de OM quando encontrada junto com células inflamatórias. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: A OM oculta é um achado incomum na RM de cães com OE crônica. Um estudo de ressonância magnética direcionado (“mini-scan bulla”) pode ser útil como parte das investigações clínicas.

Comert, Ayhan/0000-0002-9309-838X WOS: 000452441400111 PubMed: 29944552 Background: This study was designed to define the detailed anatomical relations of the jugular bulb with the facial nerve, sigmoid sinus, otic capsule, and internal acoustic canal allowing the safe management of the jugular bulb. Methods: Thirty-five formalin-perfused cadaveric temporal bones that had well mastoid and petrous pneumatization without any neurovascular variations on computed tomography scan were selected for the study. The bones were dissected via translabyrinthine approach. Results: The dome of the jugular bulb was located under the facial nerve in 21 of the cases (60%), in the mastoid cavity in 8 of the cases (22.9%), and in the tympanic cavity in 6 of the cases (17.1%). Significant difference was observed only between the temporal bones in which the dome of the jugular bulb was located in the mastoid cavity and under the facial nerve with regard to the mastoid cortex-lateral semicircular canal measurement (P = 0.04). Conclusion: Because of the high variability of the position of the dome of the jugular bulb, the precise knowledge of the relations of the jugular bulb and the preoperative radiologic verification of possible variations are essential to avoid the problems associated with its position and to decide the approach individually.

The tympanic membrane (TM) separates the outer ear from the tympanic cavity. Repeated pathologies can permanently decrease its tension, inducing conductive hearing loss and adhesive processes up to cholesteatoma. The current main therapy is its surgical reconstruction. Even though lasers have been proposed to tighten atrophic TMs, details of this effect, specifically histological analyses, are missing. We therefore used laser pulses to induce TM collagen remodeling in an animal model to compare the histological and electrophysiological effects of different applied laser intensities before entering clinical studies. We irradiated Fuchsin-stained areas of the TM in anesthetized mice with 532-nm laser-pulses of 10 mW for 30 s (0.3 J), 25 mW for 30 s (0.75 J) or 50 mW for 30 s (1.5 J) monitoring hearing with auditory brainstem responses (ABRs). The mice were sacrificed after 2 to 8 weeks and histologically analyzed. An increase in the TM thickness within the defined, stained, and irradiated areas could be observed after 4 weeks. Polarized light microscopy and transmission electron microscopy demonstrated the tissue volume increase majorly due to new collagen-fibrils. Directly after irradiation, ABR thresholds did not increase. We herein demonstrate a controlled laser-induced collagen remodeling within defined areas of the TM. This method might be the prophylactic solution for chronic inflammatory ear pathologies related to decreased TM tension.