Search

Background: Middle ear physiology includes both sound pressure transmission and homeostasis of its static air pressure. Pressure gradients are continuously created by gas exchange over the middle ear mucosa as well as by ambient pressure variations. Gas exchange models require actual values for regional mucosa thickness, blood vessel density, and diffusion distance. Such quantitative data have been scarce and limited to few histological samples from the tympanic cavity (TC) and the antrum. However, a detailed regional description of the morphological differences of the TC and mastoid air cell system (MACS) mucosa has not been available. The aim of the present study was to provide such parameters. Methods: The study included sets of three histological H&E-slides from 15 archived healthy temporal bones. We performed a comparison of the mucosa morphology among the following regions: (1) anterior TC; (2) inferior TC; (3) posterior TC; (4) superior TC; (5) MACS antrum; (6) superior MACS; (7) central MACS; (8) inferior MACS. Results: Regions (1)–(3), situated below the inter-attico-tympanic diaphragm, had the largest proportion of high respiratory epithelium, cilia and loose lamina propria within the mucosa, as well as the thickest mucosa and the largest diffusion distance. Regions (6)–(8), situated above the diaphragm, had the thinnest mucosa, the shortest distance to the blood vessels, together with the largest proportion of flat epithelium and very few cilia. Regions (4)–(5), still supradiaphragmatic, had intermediary values for these parameters, but generally closer to regions (6)–(8). The blood vessel density and the proportion of active mucosa were not significantly different among the regions. Conclusion: Mucosa of regions (1), (2) and (3) represented a predominantly clearance-specific morphology, whereas in regions (4)–(8) it seemed adapted to gas exchange. However, the lack of statistically significant differences in blood vessel density and proportion of active mucosa indicated that all regions could be involved in gas exchange with the highest adaptation in the superior MACS. This pattern divides the middle ear functionally along the inter-attico-tympanic diaphragm rather than the anatomical division into TC and MACS.

Hypothesis A total ossicular replacement prosthesis (TORP) with a silicone coated ball and socket joint (BSJ) is able to compensate pressure changes and therefore provide better sound transmission compared with rigid prostheses. Background Dislocation and extrusion are known complications after TORP reconstruction, leading to revisions and recurrent hearing loss. Poor aeration of the middle ear, scar tension, and static pressure variations in conjunction with rigid prosthesis design causes high tension at the implant coupling points. Methods A novel TORP prototype with a silicone coated BSJ has been developed. Experimental measurements were performed on nine fresh cadaveric human temporal bones of which five were used for a comparison between rigid TORP and flexible TORP tympanoplasty. The middle ear transfer function was measured at ambient pressure and at 2.5 kPa, both positive and negative pressure, applied in the ear canal. Results The flexible TORP design yields a better transmission of sound after implantation and at negative pressure inside the tympanic cavity, compared with rigid TORP. In average, it provides an equivalent sound transfer like the intact middle ear. At positive pressure, the flexible TORP performs slightly worse. Both performed worse than the intact middle ear, which is related to an uplifting of the prostheses. Conclusion The findings may be considered preliminary as this experimental study was limited to just one of the many different possible situations of tympanoplasty and it involved a small sample size. Nevertheless, the results with the flexible TORP were promising and could encourage further investigations on such prostheses.

The objective of the present work was to overview the currently available literature data on microtopographic anatomy of the anterior portion of the middle ear and the external auditory passage. Manipulations on these structures during miringoplasty surgery appear to be the most difficult and laborious operations because this space is anatomically very narrow and curved; moreover, it contains the important intimate structures of the middle ear and is located very close to the temporomandibular joint. The knowledge of microsurgical anatomy of the anterior part of the middle ear and the external auditory passage is paramount in the context of the improvement of the professional skills of the surgeons. The current literature data provide a basis for the conclusion that many aspects of microsurgical anatomy of the anterior part of the tympanic cavity and the external auditory passage thus far remain poorly explored. This assertion is especially true as regards the relief of the mucous membrane overlying these structure and their supply with arterial blood. Further clarification of these aspects is needed.Цель работы - обзор имеющихся данных литературы о микротопографической анатомии передних отделов среднего уха и наружного слухового прохода. Наиболее технически сложными и трудоемкими для отохирургов при проведении мирингопластики являются манипуляции в передних отделах среднего уха и наружного слухового прохода, что обусловлено анатомической узостью этого пространства, его изогнутостью, а также наличием интимно расположенных важных анатомических структур среднего уха и близостью височно-нижнечелюстного сустава. Знание микрохирургической анатомии передних отделов среднего уха и наружного слухового прохода является одной из важных задач в повышении профессиональных навыков отохирургов. Данные литературы позволяют сделать вывод, что до настоящего времени не все вопросы макромикроскопической анатомии передних отделов барабанной полости и наружного слухового прохода изучены, особенно рельеф слизистой оболочки и артериальное кровоснабжение. Необходимо их дополнительное изучение.

PURPOSE To describe the in vivo vascularization of middle ear by an endoscopic point of view, particularly focusing on the medial wall of tympanic cavity and incudostapedial region (ISR). STUDY DESIGN Case series with surgical videos review and anatomical description. METHODS 48 videos from exclusive endoscopic middle ear surgery performed at the University Hospital of Modena from November 2015 to July 2017 were reviewed. Data about anatomy of vessels, and blood flow direction (BFD) were collected in an appropriate database for further analyses. RESULTS 48 cases were included in the present study. In 18/48 patients (37,5%), a clearly identifiable inferior tympanic artery (ITA) was present, running just anteriorly to the round window (RW), with a superior BFD (65% of cases) from the hypotympanic region toward the epitympanum. Some promontorial variants were described in 67% of cases and the most common finding was a mucosal vascular network with a multidirectional BFD. On the ISR, an incudostapedial artery (ISA) was detected in 65% of cases with BFD going from the long process of the incus (LPI) toward the pyramidal eminence in the majority of cases. CONCLUSION The vascular anatomy and BFD of the medial wall of the tympanic cavity can be easily studied in transcanal endoscopy. ITA (with a superior BFD in most cases) and ISA (with a main BFD from the incus to the stapes) are the most constant identifiable vessels.

Introduction Myringotomy with tympanostomy tube is the most common otologic surgery and some patients are still advised to avoid water. However, there is no evidence supporting this, with published papers questioning the need for this advice. Methods A Multiphase Computational Fluid Dynamics (CFD) model was created using computerized tomography images of a child's healthy ear. It was then used to study the flow of fluids through the external ear, tympanic cavity, and auditory tube, with and without submersion. Results The model accurately described the behavior of the air retained in the patient's nasopharynx and tympanic cavity. A simulated elevation of pressure in the external auditory canal without submersion, without increase of pressure in the nasopharynx, demonstrated that fluids promptly crossed the tympanostomy tube into the middle ear. However, simulated elevation of pressure in the external auditory canal with concurrent elevation of air pressure in the nasopharynx during submersion did not lead to passive tube opening nor to any detectable flow through the tympanostomy tube. Conclusions In the model, submersion increases pressure in the nasopharynx which offsets the pressure in the external auditory canal. So, in the absence of a pressure gradient, no passive tubal opening took place, and no air or fluid flow was detected through the transtympanic tube. This model now includes the exhaust function of the auditory tube in the model and shows its relevance.

Sprague-Dawley rats are amongst the most widely used animals in biomedical research and malignant lymphoma has long been known to be a frequent neoplasm in these animals. A 9-month-old male control Sprague-Dawley rat from a toxicity study showed gelatinous material in the cranial cavity and dark, thickened cerebral meninges at necropsy. At microscopic evaluation of the temporal bone, neoplastic lymphocytes were seen invading several structures of the middle ear. The neoplastic cells appeared to extend from the marrow of the temporal bone, covered the dorsal part of the tympanic cavity wall, and surrounded and infiltrated the base of the tensor tympani muscle as well as the chorda tympani branch of the facial nerve. The lymphoma was generalized; neoplastic lymphocytes were also noted in numerous other tissues. Literature regarding neoplasms of the middle and inner ear in animals is scarce and, to our knowledge, this is the first report of a lymphoma involving the middle ear of a rat.

Primary carcinoid tumors of the middle ear are uncommon. Cytodiagnosis of the middle ear is not usually performed as a preoperative examination because of the anatomical structure of the middle ear. To the best of our knowledge, the present study reports for the first time a case of a carcinoid tumor of the middle ear, which was preoperatively diagnosed using cytodiagnosis, and also review current literature. A 22-year-old woman complained of left-sided otalgia. A subcutaneous tumor in the left middle ear was observed. Magnetic resonance imaging revealed that the tumor was primarily present in the tympanic cavity of the middle ear and extended to the mastoid antrum and mastoid cells of the middle ear and to the external acoustic meatus. Fine needle aspiration cytology was performed from the tumor protruding into the external acoustic meatus. Cytologically, the tumor was composed of small uniform cells with small round nuclei and granular eosinophilic cytoplasm, arranged in a nested pattern. Tumor cells were immunocytochemically positive for synaptophysin and cytokeratin CAM5.2. These results indicated that this was a neuroendocrine tumor. No other tumor lesions were identified on computed tomography scans, and the tumor was considered to be the primary lesion. Tympanoplasty and mastidectomy were then performed and carcinoid tumor was diagnosed in the postoperative pathological diagnosis. To the best of our knowledge, the present study is the first to report on preoperative cytodiagnosis for carcinoid tumors of the middle ear.

The objective of the present study was to demonstrate the clinical significance and possibilities of diagnostics and treatment of the intra-adenoid cysts in the nasopharynx as exemplified by an original observation of an individual case. The cystic structures in the nasopharynx rarely manifest themselves clinically and are known to produce the non-specific symptoms. The patients admitted to the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology for the surgical treatment of nasopharyngeal cysts account for 0.05% of the total number of the hospitalized subjects. This article reports a case of two large intra-adenoid cysts in the nasopharynx of one patient complicated by bilateral exudative otitis media. The successful outcome of the surgical treatment of this condition was achieved by means of endonasal marsupilization of the cysts under the laser-assisted endoscopic control with simultaneous bilateral shunting of the tympanic cavity.Цель работы - продемонстрировать клиническую значимость и возможности диагностики и лечения кистозных образований носоглотки на примере собственного клинического наблюдения. Кистозные образования носоглотки редко проявляются клинически и имеют неспецифическую симптоматику. В НИКИО им. Л.И. Свержевского доля пациентов, госпитализированных для хирургического лечения по поводу кисты носоглотки, составила 0,05%. Представлено клиническое наблюдение двух крупных интрааденоидных кист носоглотки у одного пациента, осложненных двусторонним экссудативным средним отитом. Успешное хирургическое лечение было проведено путем эндоназальной марсупиализации кист под эндоскопическим контролем с лазерной ассистенцией и одновременным шунтированием барабанных полостей с двух сторон.

Background Hemotympanum refers to both the presence of blood in the middle ear cavity and to ecchymosis of the tympanic membrane (TM), and a systematic study of intra-TM (iTM) hemorrhage without bleeding in the middle ear cavity has not been conducted. The goals of our study were to analyze the causes of iTM hemorrhage without TM perforation or bleeding in the middle ear cavity, and to demonstrate the clinical characteristics of the disease. Methods This Case series study included five patients with iTM hemorrhage between August 2014 and August 2017. An iTM hemorrhage was diagnosed when otoendoscopic examination demonstrated minor bleeding behind the intact TM, a hemorrhage was observed between the TM annulus and the epidermal layer, and temporal bone computed tomography revealed thickening of the TM without soft tissue density within the tympanic cavity or temporal bone fracture. Initial symptoms, and serial findings of otoendoscopy and pure tone audiometry (PTA) were investigated. Results iTM hemorrhage developed due to blunt head trauma in two patients, descent barotrauma during scuba diving in two patients, and spontaneous epistaxis in one patient. Otalgia and ear fullness were the most common symptoms, but PTA showed no or minimal conductive hearing loss in all patients. Conclusions An iTM hemorrhage may develop after blunt head trauma, barotrauma due to scuba diving, or spontaneous epistaxis; otological symptoms included otalgia, tinnitus, and aural fullness. An iTM hemorrhage resolved spontaneously without specific treatment, usually within 1 month.

The developmental investigation of sound transmitting apparatus is important in understanding the ontogenetic processes behind morphological diversity. The development of sound conducting apparatus was studied in Montpellier snake; Malpolon monspessulanus at 6.5, 7.2, 8.3 and 9.3 cm total body lengths using light microscopy study. The columella auris firstly appeared as undifferentiated rod shape mesenchymal cells. As the growth proceeded, it chondrified and differentiates into two main parts. In addition, the viscerocranium components which participate in formation of sound transmitting apparatus undergo critical organization. In more advanced stages, procartilagenous stylohyal chondrified and fuse with the well organized quadrate. These data considered as a base for functional and molecular mechanisms of sound transmitting apparatus studies and identification of diseases that may infect them. Resumo A investigação do desenvolvimento de equipamentos de transmissão de som é importante na compreensão dos processos ontogenéticos atrás diversidade morfológica. O desenvolvimento de aparelhos de som realização foi estudada em Montpellier cobra; Monspessulanus Malpolon em 6.5, 7.2, 8.3 e 9.3 cm corporal total utilizando comprimentos de estudo de microscopia de luz. O auris columelar em primeiro lugar apareceu como células mesenquimais forma haste indiferenciada. Como o crescimento passou, ele chondrified e diferencia em duas partes principais. Além disso, os componentes viscerocrânio que participam na formação do aparelho de transmissão de som submeter a organização crítico. Em estágios mais avançados, stylohyal procartilagenous chondrified e se fundem com o quadrado bem organizado. Estes dados considerados como uma base para os mecanismos funcionais e estudos moleculares do aparelho de transmissão de som e identificação de doenças que podem infectar-los.

Otitis media is the infection of the middle ear, caused as a result of the infection of the fluid built up in the tympanic cavity, mainly by bacteria even though viral and fungal otitis media has been reported. The bacterial isolated from the otitis media patients are known to be biofilm producers and hence the success in causing recurrent ear infections and so the detection of biofilms becomes essential as only then can effective treatment strategy be planned. As such, this paper is dedicated to finding the best method for the detection of biofilm producers in the case of otitis media causing bacteria.

Objectives: Chronic Otitis Media with Effusion (COME) is a clinical condition characterized by an effusion in the tympanic cavity. In this retrospective study, we aimed to compare the MPV and PDW value of patients with chronic otitis media with effusion (COMA) to those in healthy subjects as an inflammatory indicator. Materials and Methods: Demographic features: age, race and gender and laboratory parameters; White Blood Cell count (WBC), Red Blood Cell count (RBC), Hemoglobin (Hb), Hematocrit (Hct), Platelets (PLT), MPV and PDW were recorded after obtaining from the computerized database. Results: We included 149 patients who underwent ventilation tube insertion between with those of age and sex compatible 151 healthy subjects into the study. In our study no statistically significant differences were identified between paediatric patients diagnosed with COME and healthy controls in terms of WBC, RBC, Hb, Hct, and MPV levels (p>0.05). However, we found significant differences both the platelet count (p

This study tested the hypothesis that children with otitis media with effusion (OME) attending a primary school are at risk of impairment of their musical skills. OME is characterized as an inflammation with accumulation of secretion in the tympanic cavity, leading to conductive hearing loss.Perception of music in children is assessed using the Montreal Battery of Evaluation of Music Abilities (MBEMA). Listeners are required to judge whether two successive melodies are the same or different on tests of scale, contour, interval and rhythm. They are also queried by a memory test. A total of 92 children (49 girls and 43 boys), aged 6.0-8.0 years (mean 7.3, SD 0.7), attending a music school, were examined using the MBEMA. Twenty-three children were allocated to the OME group, while the remaining 69 to the control group. Age and gender distribution did not differ between children with OME and the controls. All participants had normal bone conduction hearing thresholds. The conductive hearing loss of the children with OME did not exceed 40 dB at any frequency. Their OME was bilateral and had lasted 3-9 months.The obtained scale, rhythm and total MBEMA scores were higher in the control group than in the OME group, with statistically significant differences for scale and rhythm scores.OME can influence music perception in children at the beginning of their school education. OME correlates with both pitch- and rhythm-related aspects of music perception.

We have developed a new clinical classification of acute otitis media (AOM) based on the previously proposed classifications of V.T. Palchun with co-workers (1997) and J. Jeger (1970) in which the letter near the stage of the pathological process roughly corresponds to the type of the tympanogram as follows: stage I (acute tubootitis): A, B, C; stage II (acute catarrhal otitis media): A, B, C; stage III (acute purulent otitis media, perforation stage); stage IV (acute purulent otitis media, post-perforation stage); stage V (resolution of otitis media): A - convalescence or recovery, B1 - exudate present in the tympanic cavity; B2 - persisting perforation; C - block of the auditory tube, O - the development of complications. This classification implies the necessity of tympanometry at the stage of diagnostics of AOM although it is not mandatory because the detection of exudate as a result of paracentesis at any of the stages of otitis media will allow to designate the stage of otitis either by letter A, B or C. The application of the new classification described in this article permits to more accurately than before determine the character of the pathological process in the middle ear during the course of acute otitis media which is of special importance in the clinical pediatric practice for the timely and adequate treatment of the children.Предложена классификация стадий острого среднего отита (ОСО) на основе классификаций В.Т. Пальчуна и соавт. (1997) и J. Jerger (1970), где буква радом со стадией процесса примерно соответствует типу тимпанограммы: I стадия - острый тубоотит: А, В, С; II - острый катаральный средний отит: А, В, С; III - острый гнойный средний отит, стадия неперфоративная; IV - острый гнойный средний отит, стадия перфоративная; V - разрешения отита: А - выздоровление; В1 - сохраняется экссудат в барабанной полости; В2 - сохраняется перфорация; С - сохраняется блок слуховой трубы; О - формирование осложнений. Использование данной классификации позволит точнее определить характер патологического процесса в среднем ухе при ОСО, что особенно важно в детской практике для проведения своевременной адекватной терапии.

Cholesteatoma is a pathological tissue that may extend into all parts of temporal bone and rarely, as this study highlights, beyond its structures. Nevertheless, the spread outside the mastoid tip into the soft tissues of the neck or parotid space is very rare. The case of 23-year-old male with right parotid mass is presented. The patient had history (2006, 2009, and 2012) of three tympanoplastics for recurrent right ear cholesteatoma. The parotid tumor was revealed incidentally in magnetic resonance imaging in January 2016, but the imaging was inconclusive. After 6 months, the patient developed right-sided facial nerve palsy. The second look of the right ear was performed with simultaneous parotid surgery. The ear was healed and free of cholesteatoma, but the parotid mass resembled the cholesteatoma confirmed later on by histological examination. The tumor extended from stylomastoid foramen. This case was unusual as the disease had extended beyond the ear with the bony parts of the mastoid being preserved. To our knowledge, this is the first case report to describe a parotid gland cholesteatoma not being an extension of a cholesteatoma present in the tympanic cavity and entering the parotid gland via stylomastoid foramen.

An English springer spaniel was presented for right-sided atrophy of the muscles of mastication, analgesia and paralysis of the face, and vestibular dysfunction. Neurological signs were consistent with a lesion involving the pons and rostral medulla resulting in deficits in the function of the trigeminal, facial, and vestibular nerves. MRI disclosed a right-sided extraparenchymal mass consistent with a trigeminal nerve sheath neoplasm that was compressing and invading the pons and medulla. Atrophy of the muscles of mastication, innervated by the trigeminal nerve, was also observed on MRI. Additionally, effusion was present in the ipsilateral tympanic cavity. Gross and microscopic evaluation of the right tensor veli palatini muscle (TVPM) was consistent with neurogenic atrophy. Effusion in the tympanic cavity was likely the result of an inability to open the auditory tube as a consequence of paralysis of the TVPM. Without the ability to open the auditory tube, gases present within the auditory tube and tympanic cavity may be absorbed, creating a negative pressure environment that leads to fluid transudation and effusion build up. To the authors' knowledge, this is the first report to document neurogenic atrophy of the TVPM with concurrent effusion in the ipsilateral tympanic cavity.

The anatomy of the middle ear is very complex. The otologist must have a good knowledge of the structures comprising the tympanic cavity; a clear view of all the subsites of this region is essential to ensure the complete removal of all pathology. The development of endoscopic techniques to access the middle ear has offered the possibility to “look around corners” and explore hidden recesses the microscope cannot reach. Moreover, by leading to a better understanding of the different ventilation pathways of the tympanic cavity, alterations of which may cause pathologies such as cholesteatoma, endoscopy represents a surgical approach aimed toward restoring normal physiology as well as eradicating disease. In this article, we discuss the state of the art of middle ear endoscopic anatomy, describing the different subsites of this small but challenging region.

Background An anterior transpetrosal approach (ATPA) is suitable for treating upper petroclival lesions. However, the limit of the ATPA is reached when the tumor extends posterolaterally over the internal auditory canal (IAC) along the petrous edge. In such cases, ligation of the posterior part of the superior petrosal sinus (SPS) is necessary. To overcome this limitation, we combined the ATPA with a partial posterior petrosectomy in 8 patients who had petroclival meningiomas extending posterolaterally over the IAC. Methods We resected only the Trautmann triangle in addition to the Kawase triangle to secure the space to ligate the posterior portion of the SPS. Because the tympanic cavity and bony labyrinth of the ear were not exposed, we were able to preserve hearing function and lower the risk of cerebrospinal fluid leakage. Furthermore, this approach enables easy ligation of the SPS and the tentorium posterior to the tumor attachment. This combined technique also allows visualization of the petrosal vein, which is important for surgery of the posterior fossa. Results Total and near-total tumor removal was achieved in 6 patients (75%) with no permanent complications and no cerebrospinal fluid leakage. Postoperative hearing impairment was not found in any of the patients who underwent this surgery. Conclusions The ATPA combined with partial posterior petrosectomy is an effective method for removal of complicated petroclival meningiomas that extend posterolaterally over the IAC along the petrous edge.

which noted some thinning of bone over superior semi-circular canal and high riding jugular bulb (Fig. 2). However, neither of these findings were considered to be the cause of his conductive hearing loss at the time. Based on the history of repeated effusions/infection, an ossicular affection was suspected and an exploratory tympanotomy was performed. Upon elevation of the tympanomeatal flap, a large bony structure was encountered in the tympanic cavity. It was confirmed to be a high riding jugular bulb and bony adhesions were identified between the bulb and the malleus, the stapes and the tympanic membrane. Additionally the jugular bulb was overlying the round window. In retrospect, these can also be seen on the CT multiplanar reformatted images (Fig. 3 and 4). The bony attachments were freed and the stapes foot plate was noted to be mobile. The jugular bulb however was not moved. The patient healed well from the surgery, but an audiogram following the procedure showed persistent moderate lowand mid-frequency 40 dB conductive loss on the right side.

Summary An 8-year-old Warmblood gelding was referred for evaluation of headshaking to the Clinic for Horses, University of Veterinary Medicine Hannover. Based on clinical signs and computed tomography – as well as magnetic resonance imaging – findings, otitis media was diagnosed. Medical treatment including trimethoprim potentiated sulfadimethoxine and meloxicam for 3 weeks did not result in cessation of clinical signs. Therefore, the tympanic cavity was opened transendoscopically using an Nd:YAG-laser via the guttural pouch according to surgical procedures in human and small animal medicine, leading to a considerable improvement of clinical signs.

Here, we introduce the “septal compass” and the “septal formula” as a new method for phylogenetic investigations of the middle ear region in squirrel-related clade. The middle ear cavity is characterized by bony septa that divide the dorsally lying epitympanic recess and the ventrally lying tympanic cavity into several segments or diverticula. The distribution patterns of these septa are conservative among the squirrel-related clade and are restricted to the species, genus, and family level. In the studied outgroups represented by †Ischyromys typus and lagomorphs, no septa are found in the epitympanic recess and tympanic cavity. Therefore, the “septal compass” and the “septal formula” provide a new approach for phylogenetic interpretations of the middle ear region. It is user-optimized and can be modified for other rodent families and mammalian taxa and will facilitate phylogenetic assumptions in future investigations. Additionally, this method will enable the allocation of isolated tympanic bullae to the respective genus level.

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25-13 kHz), equivalent input impedance at the eardrum (0.25-11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1-11 kHz), and reverse middle-ear impedance (0.25-8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold.

Postoperative mucosal regeneration of the middle ear cavity and the mastoid cavity is of great importance after middle ear surgery. However, the epithelialization of the mucosa in the middle ear is retarded because chronic inflammation without epithelialization aggravates gas exchange and clinical function. These environmental conditions in the middle ear lead to postoperative retraction and adhesion of the newly-formed tympanic membrane. Therefore, if the mucosa on the exposed middle ear bone surface can be rapidly regenerated after surgery, the surgical treatments for cholesteatoma and adhesive middle ear disease can potentially be improved. In this study, we successfully generated a cell sheet designed for the postoperative treatment of cholesteatoma. We used nasal cells to create an artificial middle ear mucosal cell sheet with a three-dimensional (3D) configuration similar to that of the middle ear mucosa. The sheets consisted of multi-layered mucosal epithelia and lower connective tissue and were similar to normal middle ear mucosa. This result indicates that tissue-engineered mucosal cell sheets would be useful to minimize complications after surgical operations in the middle ear and future clinical applications are expected. Copyright © 2015 John Wiley & Sons, Ltd.

Introduction: The aim of the middle ear surgery is to eliminate abnormalities from the mucous, ensure the due airing of the postoperative cavity and reconstruct the sound-conducting system in the middle ear. Numerous reports can be found in literature on the changes to bone conduction as a consequence of middle ear surgery. Study objective: The aim of the work is to define the factors that affect bone conduction in the patients operated on due to the perforation of the tympanic membrane with the preserved and normal mobile ossicular chain. Material and method: A prospective analysis of patients operated on due to diseases of the middle ear in 2009–2012 was carried out. The cases of patients operated on for the first time due to chronic otitis media were taken into consideration. The analysis encompassed the patients who had undergone myringoplasty. The patients were divided into several groups taking into account the abnormalities of the mucous observed during otosurgery. Results: A significant improvement of bone conduction was observed in the patients with dry perforation, without other lesions in the middle ear. The appropriate pharmacological treatment before otosurgery in patients with permanent discharge from the ear resulted in significant bone conduction improvement. The elimination of granulation lesions turned out to be a positive factor for the future improvement of the function of the inner ear. Conclusions: The lack of abnormalities on the mucous of the middle ear (e.g. granulation,) and discharge has a positive impact on improvement of bone conduction after myringoplasty. Adhesions in the tympanic cavity, especially in the niche of the round window, have a negative impact on improvement of bone conduction in patients after myringoplasty.

The opening of the round window and the insertion of the electrode array into the scala tympani during cochlear implant surgery can lead to a pressure shock of the delicate inner ear structures. By filling the tympanic cavity with Ringer Solution during these surgical steps (underwater technique), the hydrostatic pressure of the fluid acts as a smooth pressure stabilizer, avoiding a pressure shock of the inner ear structures. The aim of this retrospective study was to present long-term results of this new method of cochlear implantation in underwater technique. Altogether, 47 implantations in 43 patients with residual hearing at the frequencies 250, 500 and 1000 Hz in the unaided preoperative pure tone audiometry were included. A cochlear implantation via round window with a conventional full-length electrode was performed in underwater technique. Changes of residual hearing 7 weeks and 24 months after surgery were analyzed. Overall postimplant hearing preservation 7 weeks after implantation was achieved in 22 ears (47%). Subsequent follow-up was performed on average 24 months after surgery (range 12 months–4.2 years) in all patients. At this late postoperative evaluation, preservation of hearing was recorded in 18 ears (38%). Neither the follow-up time nor the type of electrode had a significant impact on the postoperative hearing loss. The underwater technique is an atraumatic cochlear implantation technique with hearing preservation rates comparable to results in literature and a very small hearing preservation decline rate over time even when using full-length CI electrodes.

Objective:To present the auditory implant manipulator, a navigation-controlled mechanical and electronic system which enables minimally invasive (‘keyhole’) transmastoid access to the tympanic cavity.Materials and methods:The auditory implant manipulator is a miniaturised robotic system with five axes of movement and an integrated drill. It can be mounted on the operating table. We evaluated the surgical work field provided by the system, and the work sequence involved, using an anatomical whole head specimen.Results:The work field provided by the auditory implant manipulator is considerably greater than required for conventional mastoidectomy. The work sequence for a keyhole procedure included pre-operative planning, arrangement of equipment, the procedure itself and post-operative analysis.Conclusion:Although system improvements are necessary, our preliminary results indicate that the auditory implant manipulator has the potential to perform keyhole insertion of implantable hearing devices.

Serous otitis media is a serosal inflammation of the mucous membrane of the auditory tube and the tympanic cavity which develops on the background of Eustachian tube dysfunction. It is characterized by the presence of seromucous exudate in the tympanic cavity. The disease occurs more often in children than adults. The objective of the research was to compare the effectiveness of different methods of treating serous otitis media. Materials and methods. The study included 46 patients with serous otitis media at the age of 22-55 years. There were 26 females and 20 males who were treated as inpatients and outpatients in the department of microsurgery of ENT-organs in Ivano-Frankivsk Central City Clinical Hospital during 2012-2016. Disease duration ranged from 10-15 days to 1 month. In all the patients, serous otitis media developed on the background of persistent allergic rhinitis. All the patients underwent comprehensive examination: their complaints as well as anamnestic data were analyzed, ENT examination including the endoscopic examination of the nasal cavity and the nasopharynx, otoscopy, audiometry, impedancemetry and laboratory investigations was performed. All patients were divided into 2 groups: Group I included 21 patients receiving conservative therapy for allergic rhinitis and serous otitis media; Group II comprised 25 patients receiving conservative therapy for allergic rhinitis and treatment of serous otitis media applying myringotomy and bypass surgery of the tympanic cavity. Results. The analysis of the study revealed that in 9 patients of Group I, an improvement in hearing occurred on the third-fourth days after treatment. In 12 patients, treatment was ineffective. 14 patients of Group II who underwent myringotomy with the evacuation of the fluid from the tympanic cavity and subsequent injection of glucocorticoids into the tympanic cavity noted an improvement in hearing immediately after the procedure or the day after. In 11 patients of Group II, a thick mucous exudate was obtained during myringotomy. These patients underwent bypass surgery. The shunt was removed after a thorough cleaning of the tympanic cavity as well as the restoration of the auditory tube function. Conclusions. Myringotomy is more effective and rational method of treating serous otitis media. Myringotomy with subsequent bypass surgery is recommended for patients with a thick mucous exudate in the tympanic cavity in order to prevent chronic adhesive otitis as well as to perform a complete sanation of the tympanic cavity and to restore the auditory tube function.

The ears, specifically the internal ear, house the receptors for the special senses of hearing and balance, which are extraordinary in the cat. The ear consists of three anatomically and functionally distinct parts: the external ear, the middle ear, and the internal ear. The auricle includes a number of ridges and prominences that give the ear base its distinct appearance. The inner surface of the initial part of the external ear canal has numerous prominent ridges with furrows between them. The long, narrow scutiform cartilage, although not forming part of the external ear, is closely connected with it. The middle ear includes the tympanic membrane, the tympanic cavity and its contents, and the auditory tube. The pars tympanica makes up the lateral wall and surrounds the opening of the osseous external auditory meatus. The air-filled space of the tympanic cavity communicates via the auditory tube with the nasopharynx to maintain equal pressure on either side of the tympanic membrane.

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., Хирургические вмешательства на среднем ухе у недоношенных детей требуют точного знания топографо-анатомических особенностей строения височной кости.Цель: изучить топографо-анатомические особенности среднего уха у плодов 9 месяцев внутриутробного развития и обосновать морфологическую взаимосвязь формообразующих процессов его с прилегающими структурами.Материалы и методы. Исследование выполнено на семи плодах человека 311,0–345,0 мм теменно-копчиковой длины. В ходе исследования использовали методы тонкого препарирования среднего уха и прилегающих участков под контролем бинокулярной лупы, макро- и микроскопии, морфометрии, макрофотографии цифровым фотоаппаратом OLIMPUS μ 1000 All-weather 10,0 MPix.Результаты. У плодов девятого месяца внутриутробного развития барабанная полость приобретает более неправильную форму, на ее стенках появляются многочисленные ячейки; продолжается формирование нижней и передней стенок барабанной полости и надбарабанного пространства; барабанные отверстия слуховых труб начинают перемещаться из нижней части барабанной полости вверх.Выводы. Установленные особенности строения барабанной полости у плода человека 9-месячного возраста имеют важное значение для усовершенствования технологий и адекватности хирургического лечения и манипуляций у преждевременно родившихся детей., Хірургічні втручання на середньому вусі у недоношених дітей вимагають точного знання топографо-анатомічних особливостей будови скроневої кістки.Мета: вивчити топографо-анатомічні особливості середнього вуха у плодів 9-ти місяців внутрішньоутробного розвитку та обґрунтувати морфологічний взаємозв'язок формотворчих процесів його з прилеглими структурами.Матеріали і методи. Дослідження виконано на семи плодах людини 311,0–345,0 мм тім'яно-куприкової довжини. У ході дослідження використовували методи тонкого препарування середнього вуха та прилеглих ділянок під контролем бінокулярної лупи, макро- та мікроскопії, морфометрії, макрофотографії цифровим фотоапаратом OLIMPUS μ 1000 All-weather 10,0 MPix.Результати. У плодів дев'ятого місяця внутрішньоутробного розвитку барабанна порожнина набуває більш неправильної форми, на її стінках з'являються численні комірки, продовжується формування нижньої та передньої стінок барабанної порожнини та надбарабанного простору, барабанні отвори слухових труб починають переміщуватися з нижньої частини барабанної порожнини доверху.Висновки. Визначені особливості будови барабанної порожнини у плода людини 9місячного віку мають важливе значення для удосконалення технологій і адекватності хірургічного лікування та маніпуляцій у передчасно народжених дітей.

The anterior anchoring of the malleus of 30 extant species of Lagomorpha (rabbits, hares, pikas) has been studied on the basis of histological serial sections and µCT-scans. It is shown that former studies of Oryctolagus, Lepus, and Ochotona are incomplete, because the rostral part of the processus anterior of the malleus is always lacking due to damage of this extremely delicate structure. Our study shows that in perinatal stages of Leporidae the praearticulare develops a prominent processus internus that fits into a groove at the ventral side of the tegmen tympani; this "tongue and groove"-arrangement may act as a hinge. In adult stages, the rostral end of the praearticulare fuses synostotically with the medial process of the ectotympanic. Torsional strain produced by rotation around the axis of the middle ear ossicles at sound transmission must, therefore, be experienced by the extremely thin but highly elastic bony pedicle of the processus internus praearticularis. The free ending processus anterior of a late fetal Ochotona shows a short processus internus praearticularis, which does not articulate with the tegmen tympani. During postnatal development the middle ear of Ochotona becomes considerably remodelled: not only does excessive pneumatization of the tegmen tympani and tympanic cavity wall occur, but the short processus anterior is fused synostotically to a bone trabecula of the tegmen tympani meshwork. The thin and elastic bone bridges are not equivalent in Leporidae and Ochotonidae, that is, they must have evolved convergently. Fleischer's classification with Oryctolagus possessing a "freely mobile type" of middle ear ossicles cannot be supported by our observations. The same holds true for Ochotona, which does not represent a "freely mobile type" either. Thus, we suggest for the lagomorph middle ear ossicles a new category: the "bone elasticity type."

The recurrent cholesteatomic process is one of the main causes of the poor outcome of the surgical treatment in the patients with acquired cholesteatoma of the middle ear. The relapse can be due to the incomplete removal of the cholesteatomic matrix especially from the difficult to access for visual control during the surgical intervention parts of the anterior epitympanic space, medial sinuses of retrotympanum, deep-lying portions of hypotympanum, and retrofacial part of the mastoid cavity. One more cause behind the recurrent process is the retention of the conditions for the secondary retraction of the neotympanic membrane, The objective of the present study was the improvement of the surgical modalities for better visualization and sanation of the difficult to access anatomically complex parts of the middle ear under the eye control, the creation of the conditions for the additional ventilation of the tympanic cavity and the reduction of the risk of development of residual and/or recurrent cholesteatomas. To this effect, we undertook the analysis of the results of 438 primary and 226 secondary (revisional) surgical interventions on the patients presenting with chronic suppurative otitis media and concomitant cholesteatomas. The study has demonstrated that the cause of 14.6% of the cases of residual cholesteatoma was the incomplete removal of its matrix from the anterior epitympanic space, medial sinuses of retrotympanum, deep-lying portions of hypotympanum, and retrofacial part of the mastoid cavity. The proposed surgical strategies reduced the risk of development of residual cholesteatoma from 8.2% to 3.9%. The newly developed method for the additional ventilation of the tympanic cavity allowed the frequency of recurrent cholesteatoma to be decreased from 2.5% to 1.6%.Одной из основных причин неблагоприятного исхода хирургического лечения больных с приобретенной холестеатомой среднего уха является рецидив холестеатомного процесса. Это связано либо с неполным удалением холестеатомного матрикса, особенно из мест, труднодоступных для визуального контроля в процессе хирургического вмешательства: переднего эпитимпанального пространства, медиальных синусов ретротимпанума, глубоких отделов гипотимпанума, ретрофациального отдела сосцевидной полости; либо с сохранением условий для повторного втяжения неотимпанальной мембраны. Цель настоящего исследования - совершенствование хирургических подходов, позволяющих улучшить визуализацию и санацию под зрительным контролем анатомически сложных участков среднего уха, а также создающих условия для дополнительной вентиляции тимпанальной полости, уменьшающих риск развития резидуальной и/или рекуррентной холестеатомы. Для этого проведен анализ результатов 438 первичных и 226 ревизионных хирургических вмешательств у больных с хроническим гнойным средним отитом с холестеатомой. Исследование показало, что в 14,6% случаев причиной формирования резидуальной холестеатомы явилось неполное удаление ее матрикса из переднего эпитимпанального пространства, медиальных синусов ретротимпанума, глубоких отделов гипотимпанума, ретрофациального отдела мастоидальной полости. Предложенные хирургические подходы снизили риск развития резидуальной холестеатомы с 8,2 до 3,9%. Разработанная методика создания дополнительных путей вентиляции тимпанальной полости уменьшила частоту рекуррентной холестеатомы с 2,5 до 1,6%.Одной из основных причин неблагоприятного исхода хирургического лечения больных с приобретенной холестеатомой среднего уха является рецидив холестеатомного процесса. Это связано либо с неполным удалением холестеатомного матрикса, особенно из мест, труднодоступных для визуального контроля в процессе хирургического вмешательства: переднего эпитимпанального пространства, медиальных синусов ретротимпанума, глубоких отделов гипотимпанума, ретрофациального отдела сосцевидной полости; либо с сохранением условий для повторного втяжения неотимпанальной мембраны. Цель настоящего исследования - совершенствование хирургических подходов, позволяющих улучшить визуализацию и санацию под зрительным контролем анатомически сложных участков среднего уха, а также создающих условия для дополнительной вентиляции тимпанальной полости, уменьшающих риск развития резидуальной и/или рекуррентной холестеатомы. Для этого проведен анализ результатов 438 первичных и 226 ревизионных хирургических вмешательств у больных с хроническим гнойным средним отитом с холестеатомой. Исследование показало, что в 14,6% случаев причиной формирования резидуальной холестеатомы явилось неполное удаление ее матрикса из переднего эпитимпанального пространства, медиальных синусов ретротимпанума, глубоких отделов гипотимпанума, ретрофациального отдела мастоидальной полости. Предложенные хирургические подходы снизили риск развития резидуальной холестеатомы с 8,2 до 3,9%. Разработанная методика создания дополнительных путей вентиляции тимпанальной полости уменьшила частоту рекуррентной холестеатомы с 2,5 до 1,6%.

The article presents a case of the middle ear obliteration in a 45 years old female patient that complained of a long-term continuous otorrhea and underwent 4 surgeries for congenital middle ear development abnormality (microtia, external auditory canal (EAC) atresia), paraauricular fistula and stage 3 chronic sensoneural hearing loss. The work provides detailed description of the course of interference that resulted in the fact, that no complaints of the operated ear have been observed for 12 months. Therefore, the fat tissue obliteration of tympanic cavity may be used as the method of choice in case of treatment of post-surgical cavity without result in patients with the chronic suppurative otitis media in the cases where reconstructive hearing improvement surgery is impossible or is not indicated. The latter is observed in the patients with the expressed sensoneural hearing loss.

Otitis media is a group of inflammatory diseases of the middle ear. Acute otitis media and otitis media with effusion (OME) are its two main types of manifestation. Otitis media is common in children and can result in structural alterations in the middle ear which will lead to hearing losses. This work studies the effects of an OME on the sound transmission from the external auditory meatus to the inner ear. The finite element method was applied on the present biomechanical study. The numerical model used in this work was built based on the geometrical information obtained from The visible ear project. The present work explains the mechanisms by which the presence of fluid in the middle ear affects hearing by calculating the magnitude, phase and reduction of the normalized umbo velocity and also the magnitude and phase of the normalized stapes velocity. A sound pressure level of 90 dB SPL was applied at the tympanic membrane. The harmonic analysis was performed with the auditory frequency varying from 100 Hz to 10 kHz. A decrease in the response of the normalized umbo and stapes velocity as the tympanic cavity was filled with fluid was obtained. The decrease was more accentuated at the umbo.

Eustachian Tube Dysfunction (ETD) is an ailment many people suffer, yet the exact cause of the problem is a subject for research. A tympanic cavity air exchange sensor is designed and used for monitoring the air exchange during operation of the Eustachian tube. Observation of EMG activity of muscles together with the observation of air exchange activity of Eustachian Tube while the Eustachian Tube opens, have revealed important information about the state of Eustachian Tube and the ETD problem. Early results suggest the possibility of a new way of identifying deteriorating status of the Eustachian Tube before it becomes totally dysfunctional and even classifying ETD dysfunction levels according to the output provided by the Tympanic Cavity Air Exchange sensor. This paper intends to provide the design details of the air exchange sensor used in the experiments and explain how the sensor was used to get information about the state of Eustachian Tube Dysfunction problem.

Introduction The middle ear ossicles form a semi rigid chain in the middle of the ear for conduction and amplification of sound waves from the tympanic membrane to the inner ear. Although, our knowledge of the ear ossicles dates back to the 15th century, and various studies have been carried out on their morphometry, morphology, anomalies, embryology, function and structure throughout the world, information about the morphology of middle ear ossicles is meagre in Indian subjects. Aim To find out the morphological variations of middle ear ossicles of right and left sides. Materials and methods In the present study, the middle ear ossicles were bilaterally dissected out from the temporal bones obtained from 26 cadaveric heads from the Department of Anatomy under a surgical oto-microscope with micro instruments. Morphological variations were studied under the magnification of the operating microscope. Attempt was also made to evaluate the clinical implications related to such variants and compare the results with those observations made in other parts of India and abroad. Age variation was not considered as the ossicles reach their full size at birth. Results It was observed that the stapes was the most variable and the incus as the most stable ossicle so far as morphological variations are concerned. Malleus presented variations in the free ends of manubrium, lateral process and anterior process. Variation in morphology of stapes did not follow any fixed pattern. Conclusion It is expected that this work may also inspire many others to continue temporal bone dissection with a view to gather more ossicles which might be preserved in ossicular banks by following proper sterilization methods for future use as homografts in ossiculoplasty. These harvested ossicles may be used to replace eroded middle ear ossicles as an alternative to manufactured prosthesis.

Purpose To depict the anatomy of the tympanic segment of the facial canal using a 3D visualization technique, to detect dehiscences, and to evaluate their frequency, location, shape, and size. Methods Research included 36 human temporal bones (18 infant and 18 adult samples) which were scanned using a Nanotom 180N device. The final resolution of the reconstructed object was 18 µm. Obtained micro-CT data were subsequently processed by the volume rendering software. Results The micro-CT study allowed for the 3D visualization of the tympanic segment of the facial canal and detects dehiscences in the studied material in both infants and adults. Most of the dehiscences (66.7 %) involved the inferior wall of the tympanic segment in infants as well as in adults, and were located above and backward to the oval window. The most frequent dehiscence shape was elliptic (66.7 % in infants; 50 % in adults). Furthermore, we observed dehiscences of fusiform and trapezoidal shape in infants. Length of the dehiscences in most cases ranged from 0.5 to 1.4 mm (50 % in infants; 75 % in adults). Conclusions Volumetric reconstructions demonstrated the course of the tympanic segment of the facial canal and its relationship with the tympanic cavity. Knowledge about the size and location of any dehiscence within the tympanic segment of the facial canal is necessary due to the surgical significance of this region. If a dehiscence occurs, there is an increased risk of injury to the facial nerve during the operations or spread of inflammation from the middle ear.

The inner ear is an important structure in the hearing system and in the balance sensibility for a human. The ear anatomy, especially the cochlea's, has a complex structure that makes disease treatment difficult. A liquid called perilymph is trapped in the cochlea by the Round Window Membrane (RWM). A leak of this liquid would result in a total loss of hearing which limits the possibility treatment by injecting drugs in the tympanic cavity, close to the RWM, to ensure that the maximum quantity of drugs is able to pass through it. The problem of this method is the side effects caused by drugs. The use of magnetic nanoparticles could be an alternative to massive drug delivery. This chapter aims to review the current knowledge concerning the RWM structure to define the best model, close to the real structure, to push magnetic particles through it.

Facial nerve is the seventh paired cranial nerve. The main trunk of CN VII consists of motor fibers and the intermediate nerve which is a part of CN VII has parasympathetic and sensory fibers. One of the branches of CN VII is the chorda tympani which may play a significant role in responses related to normal Eustachian tube function. Other branches of CN VII, such as the greater petrosal nerve and tympanic branch, have motor fibers that open the Eustachian tube, which connects the tympanic cavity with the nasopharynx. It is located at the base of the cranium and consists of bone and cartilage. To evaluate the Eustachian tube and middle ear function, impedance audiometry (IA) is used. It is specifically used in hearing organ evaluation in children. The impedance audiometry consists of tympanometry, registration of reflex from the stapedius muscle and evaluation of Eustachian tube function. Tympanometry is an examination, evaluating response of the tympanic membrane and related structures of the middle ear on artificially induced pressure changes in the external auditory meatus. The main aim of the article is to evaluate middle ear function in children and adolescents with peripheral facial nerve palsy using results obtained in tympanometry and comparing the values for pressure, amplitude, and tympanometric curve gradient between the side with CV VII palsy (affected side) and the opposite side (healthy side).

BACKGROUND AND PURPOSE: MR imaging is often used for detecting intracranial complications of acute mastoiditis, whereas the intratemporal appearance of mastoiditis has been overlooked. The aim of this study was to assess the imaging features caused by acute mastoiditis in MR imaging and their clinical relevance. MATERIALS AND METHODS: Medical records and MR imaging findings of 31 patients with acute mastoiditis (21 adults, 10 children) were analyzed retrospectively. The degree of opacification in the temporal bone, signal and enhancement characteristics, bone destruction, and the presence of complications were correlated with clinical history and outcome data, with pediatric and adult patients compared. RESULTS: Most patients had ≥50% of the tympanic cavity and 100% of the mastoid antrum and air cells opacified. Compared with CSF, they also showed intramastoid signal changes in T1 spin-echo, T2 TSE, CISS, and DWI sequences; and intramastoid, outer periosteal, and perimastoid dural enhancement. The most common complications in MR imaging were intratemporal abscess (23%), subperiosteal abscess (19%), and labyrinth involvement (16%). Children had a significantly higher prevalence of total opacification of the tympanic cavity (80% versus 19%) and mastoid air cells (90% versus 21%), intense intramastoid enhancement (90% versus 33%), outer cortical bone destruction (70% versus 10%), subperiosteal abscess (50% versus 5%), and perimastoid meningeal enhancement (80% versus 33%). CONCLUSIONS: Acute mastoiditis causes several intra- and extratemporal changes on MR imaging. Total opacification of the tympanic cavity and the mastoid, intense intramastoid enhancement, perimastoid dural enhancement, bone erosion, and extracranial complications are more frequent in children.

Purpose The most common causative factors of CSF otorrhea in children are injuries and congenital abnormalities of the temporal bone. Spontaneous CSF leak as a consequence of congenital temporal bone defects may result in recurrent meningitis. Diagnosis and management of such an entity are particularly difficult in early childhood. Materials and methods The aim of this study was to investigate clinical features and to discuss possible methods of treatment of spontaneous CSF otorrhea in children. Results Severe unilateral sensorineural hearing loss or total deafness was found in children with CSF otorrhea. CT and MRI of the temporal bones revealed dehiscences in the walls of the tympanic cavity and defects of the inner ear, which were confirmed intraoperatively. Lateral petrosectomy and closure of the fistula with muscle tissue and fat obliteration cavity were performed. The children remain free of otorrhea and recurrences of meningitis. Conclusion The diagnosis of spontaneous otorrhea in children is based on the severe unilateral sensorineural hearing loss and presence of CSF in the middle ear cavity. It may be successfully treated by means of lateral petrosectomy with obliteration of the vestibule with muscle tissue and tympanic cavity with fat tissue.

Rounded, sessile, hyperattenuating structures detected in computed tomography (CT) studies of canine tympanic bullae have been termed “otoliths.” These have been proposed to represent dystrophic mineralizations or heterotopic bone formations in the middle ear that are potentially related to chronic otitis media. Aims of the current study were to describe the prevalence, macroscopic, and histological features of structures consistent with “otoliths” in the canine tympanic cavity. Tympanic bullae from 50 routinely necropsied dogs and 139 retrospectively retrieved CT scans of canine clinical cases were examined. Small tympanic bone spicules with pointed or clubbed tips essentially arising from the free margin of the septum bullae were bilaterally present in the tympanic cavities of all 50 of the necropsied dogs. In 48% of the dogs, “otolith”-like CT-detectable bone spicules carrying drumstick-like hyperostoses that were 1–6 mm in diameter were also present. In the retrospective survey of bulla CT scans of 139 cases, the prevalence of hyperostotic tympanic bone spicules (HTBS) was 20%. Findings from the current study indicated that the presence of small tympanic bone spicules in adult dogs is most likely due to physiological bone growth in the septum bullae and that HTBS represent osseous proliferations of small tympanic bone spicules. However, the factors inducing formation of hyperostotic spicules from small tympanic bone spicules remain unknown. The high prevalence of HTBS displaying a similar appearance in bulla CT scans in dogs suggests that these spicules should be included in a differential diagnosis list for “otoliths.”

Background: The inlay cartilage butterfly myringoplasty is a simple technique with few complications for closure of tympanic membrane defects introduced by Eavey 1998, but still not often used. Its advantages consist in avoiding of exposure the tympanic cavity and possible blunting, option to operate both ears at once, safe local anaesthesia, reduction of operation time and cost, minimal postoperative care and patient comfort. Patients and Methods: We operated 10 patients using a to date not described simple cartilage transplant without perichondrium. Reason, localisation, extent and duration of the defect as well as complications, patient assessment and pure tone audiogram were analysed. Results: All defects were closed six months postoperative. Seven patients rated hearing as improved, two as non-changed and one patient showed deafness in the pure tone audiogram pre- and postoperative. The average air-bone gap of the thresholds at frequencies 0.5, 1, 2 and 3 kHz was 8.6 dB postoperative as compared to 16.3 dB preoperative. It could be shown that pure cartilage transplants without perichondrium used for defects up to 6mm in diameter were enwrapped by the tympanic membrane and covered by capillaries. Conclusion: The inlay cartilage butterfly myringoplasty is a safe and gentle technique for tympanic membrane defect closure.

The objective of the current study was to determine the anatomical features of the tympanic cavity in cattle and buffalo and to be recognize all parts of the tympanic cavity for its clinical purposes. There are general anatomical explanation about the middle ear in anatomy text book, however there are no studies in the literature on the morphology of the tympanic cavity in the buffalo, the region is important clinically as a frequent point of attachment for prostheses. As a recent studies have focused on the reconstruction of defects occurring in these tympanic cavity to aid in the development of new surgical technique. Twelve temporal bones from six heads of adult cattle and buffalo were used, the cavity had been investigated on both sides after dissection them, the features of the cavity were assessed with a measurement done by using digital veirenear calipers and measurement tap and photograph by a stereomicroscope. The result show that the tympanic cavity can be divided into three parts, dorsal (epitympanic recess) middle (proper tympanic cavity) and ventral (tympanic bulla), size communicating freely with each other. Epitympanic recess has handle the head of the malleus ,which embedded in the medial surface of tympanic membrane , the proper tympanic cavity has three ossicles are connected to each other , in buffalo being the most developed and the ossicles of the cattle are relatively small , but the incus is more pronounced. Malleus is intimately fused with the incus, it was therefore not possible to separate the malleus and incus. The proper tympanic cavity has tympanic membrane the membrane can be divided into pars flaccids and pars tensa, in buffalo was more development, large in size and oval in shape, with a darker color and thick, but in cattle was rectangle in shape, with a lighter color and thin comparative with buffalo. The tympanic cavity has two skeletal muscles (stapedius and tensor tympanic muscles), the stapedius muscle is ill developed and the greater part of the tensor tympanic muscle was tendinous in buffalo. The proper tympanic cavity has four opening, the external acoustic meatus, the fenestra ovals, the fenestra rotundum and the Eustachian tube. The first three opening are closed by membrane partitions, the Eustachian tube or the auditory tube is short, and (4-5) cm in length and this can clearly why the tympanic cavity of the animal is easily susptable for infections. The ventral of the tympanic cavity was sieve - like present large number of formation which continues with the air cell of the tympanic bulla, the cell which lie directly ventral to the proper tympanic cavity was communicate with those around the external acoustic meatus and facial canal .

Introduction Endoscopic-assisted microsurgery of the middle ear enables the field of view of the surgeon to be expanded during the removal of inflammatory tissue from the tympanic cavity and during myringo- and ossiculoplasty. Canal wall up tympanoplasty with posterior tympanotomy is a gold standard in surgical treatment of chronic otitis media. Most applications of endoscopy in middle ear surgery concern exclusively the endoscopic transcanal approach. Aim To determine the usefulness of endoscopic visualization during the standard surgical approach through the posterior tympanotomy. Material and methods The study compared the visualization of the elements of the middle ear through the posterior tympanotomy by endoscopes with 30° and 45° optics and a microscope. Posterior tympanotomy was performed in eleven temporal bones. Visualization of the tympanic recesses was assessed on a subjective scale. A microscope and 30° and 45° endoscopes were used for inspection of the hypotympanum, sinus tympani, Eustachian tube, Prussak's space and footplate. Friedman ANOVA test and Dunn's multiple comparisons test were used for statistical analysis of the data. Results Visualization of particular recesses by endoscopes, both 30° and 45°, was excellent, while the microscopic view was statistically significantly worse, especially for sinus tympani, Prussak's space and footplate. There were no significant differences in visibility of the middle ear spaces between the two types of endoscopic optics. Conclusions Additional application of the endoscopes during middle ear surgery provides valuable information due to excellent visualization of key recesses usually hidden from the microscope.

Paragangliomas are benign tumors that originates from paraganglia of parasympathetic nervous system. They are characterized by slow growth and late clinical symptoms. In the head and neck localize around carotid bifurcation, jugular bulb, along the vagus nerve and in the tympanic cavity. Typical complaints are: pulsatile tinnitus and hearing loss initially conductive, and as the disease progresses sensorineural hearing loss. Diagnosis of these tumors at an early stage of development allows the selection of optimal treatment and radical removal of the tumor. Authors presented a case of huge paraganglioma, which progressed significantly during observation period. Tumor extended within temporal bone, external auditory canal and intracranially. The patient was treated surgically. A near total resection of the tumor was performed with consecutive facial nerve reconstruction.

Objectives: The middle ear cleft connects by membranes to the inner ear and the subarachnoid space particularly in infants. In order to gain more insight about the permeability between the two compartments we quantified the concentration of beta-trace protein - a highly specific marker for CSF and perilymph but not for serum and mucosal effusion - in meddle ear secretions from children with otitis media with effusion. Methods: One-hundred and three patients were included and 93 samples from secretory otitis media were collected during myringotomy or explorative tympanotomy. Thirty-eight patients of 103 had to be excluded (36.9 %). Of the 93 collected samples from 65 subjects, 82 viscous samples were pre-diluted 1:1 with tyloxapol. In spite of the attempt to pre-dilute the viscous samples, 30 glue-like samples of 93 were not applicable for nephelometry. The final analysis was made on 63 samples of 52 subjects (median age 3 years) which were quantified for beta-trace protein using immunophelometry. Results: In 3/63 samples the beta-trace protein values were below the detection range (0.2 mg/l) and in 1/63 was beyond with 18.3 mg/l. The median beta-trace protein value for 59 samples within the measuring range was 2.4 mg/l, range 0.2-14.2. Conclusion: In pediatric middle ear effusions, the beta-trace protein concentration was found to have a high range compared to other body fluids from other studies. In other studies, the values for serum (0.59 mg/l) or mucosal secretion (0.003-0.12 mg/l) were lower and the values in CFS (18.4 mg/l) or perilymphatic fluid (23.5 mg/l) were hightest. This finding might indicate a weak barrier between the cerebrospinal fluid space or inner ear fluid compartments on the one side and the tympanic cavity on the other side given the condition of otitis media effusion. The detection of beta-trace protein might be important to assess the risk of impending complications.

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

Introduction Middle ear barotrauma is the most common side effect of hyperbaric oxygen therapy. Knowledge and understanding of its pathophysiology are crucial for an accurate diagnosis and proper decision making about treatment and prevention. Objective Describe up-to-date information on pathophysiology of middle ear barotrauma after hyperbaric oxygen therapy considering the physiology of pressure variation of the middle ear. Data Synthesis Middle ear barotrauma occurs especially during the compression phase of hyperbaric oxygen therapy. The hyperoxic environment in hyperbaric oxygen therapy leads to ventilatory dysfunction of the eustachian tube, especially in monoplace chambers, where the patients are pressurized with 100% O2, favoring middle ear barotrauma. Conclusion The eustachian tube, the tympanic cavity, and mastoid work together in a neural controlled feedback system in which various mechanisms concur for middle ear pressure regulation.

Objectives Presence of aberrant internal carotid artery (ICA) in the tympanic cavity is a very rare case and therefore the diagnosis is a challenge. Here, the authors aimed to address the importance of the diagnosis since the intervention to the middle ear and implants is increasing in number and this condition may lead to life-threatening bleeding. Methods Between 2012 and 2016, among the patients referred to the authors' Radiology Department from the Department of Otolaringology for the evaluation of the temporal region for various indications, the authors reported this anomaly in 6 patients and multidetector computerized tomography of these 6 patients and magnetic resonance imaging of 2 were assessed in detail. Results The mean age of the 6 patients was 28.8 and aberrant ICA abnormality was observed in 2 patients bilaterally and 4 patients unilaterally on the right side. In 1 patient ICA was not totally regressed and observed as hypoplastic. In one of the patients, dehiscence was evident between ICA and the cochlea. Moreover, in 1 patient the contralateral ICA was not observed. Conclusion Although rare, aberrant ICA is an abnormality that should be kept in mind by the clinicians and the radiologists, since it leads to abundant bleeding when undiagnosed before the surgical interventions.