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While common in the paranasal sinuses, the presence of allergic mucin within the middle ear is rare. Here we describe a case of what has been termed allergic fungal otomastoiditis (AFOM), an unusual immunologic response to the presence of fungal hyphae within the middle ear, with a unique presentation of aural polyps. A 25-year-old woman presented with recurrent right-sided aural polyps and chronic otorrhea, despite two previous tympanomastoidectomy surgeries performed in India. CT scan of the temporal bones demonstrated complete opacification of the tympanic cavity and mastoid. Canal wall down tympanomastoidectomy was performed, revealing thick otorrhea and polyps filling the external auditory canal and middle ear, eroding the entire tympanic membrane and obstructing the antrum. Pathology revealed glandular and squamous metaplasia, marked inflammation with eosinophils, as well as allergic-type mucin with non-invasive fungal hyphae highlighted by GMS stain. The histopathologic findings of AFOM are reminiscent of allergic fungal rhinosinusitis (AFRS) and suggest a similar pathophysiology. Optimal treatment in these cases may require a combination of surgical debridement and medical management. AFOM should be considered in the differential diagnosis of chronic otitis media, particularly in the presence of aural polyps and thick otorrhea.

Objective The aim of this study was to profile and compare the middle ear microbiomes of human subjects with and without chronic otitis media. Study Design Prospective multicenter cohort study. Methods All consecutive patients undergoing tympanoplasty surgery for chronic otitis media or ear surgery for conditions other than otitis media were recruited. Sterile swab samples were collected from the middle ear mucosa during surgery. The variable region 4 of the 16S rRNA gene in each sample were amplified using region-specific primers adapted for the Illumina MiSeq sequencer (Illumina, CA, USA)). The sequences were subjected to local blast and classified using Metagenome@KIN (World Fusion, Tokyo, Japan). Results In total, 155 participants were recruited from seven medical centers. Of these, 88 and 67 had chronic otitis media and normal middle ears, respectively. The most abundant bacterial phyla on the mucosal surfaces of the normal middle ears were Proteobacteria, followed by Actinobacteria, Firmicutes, and Bacteroidetes. The children and adults with normal middle ears differed significantly in terms of middle ear microbiomes. Subjects with chronic otitis media without active inflammation (dry ear) had similar middle ear microbiomes as the normal middle ears group. Subjects with chronic otitis media with active inflammation (wet ear) had a lower prevalence of Proteobacteria and a higher prevalence of Firmicutes than the normal middle ears. Conclusion The human middle ear is inhabited by more diverse microbial communities than was previously thought. Alteration of the middle ear microbiome may contribute to the pathogenesis of chronic otitis media with active inflammation. Level of Evidence 2b. Laryngoscope, 127:E371–E377, 2017

The technical aspects of endoscopic otosugery imply the necessity of the long-term intense preparation of the specialists. Mastering new endoscopic techniques constitute a serious challenge even for a physician having the many years' experience of work with the binocular microscope which dictates the necessity of introduction of the simulation technologies for the training in endoscopic operations. The results of the analysis of the relevant literature publications provided a basis for the development of the methodology for teaching the skills of endoscopic tympanoplasty (ET) based on the use of the simulation models. MATERIAL AND METHODS: We have undertaken the morphometric analysis of various structures of the sheep external and internal ears based on the results of investigations with the use of computed tomography (n=15). The consideration of the data obtained by this radiodiagnostic technique made it possible to determine the mean length and the horizontal diameter of the external auditory meatus, the horizontal size and the area of the tympanic membrane, and the slope angle of the tympanic membrane with respect to the external auditory meatus, the volume of the tympanic cavity, and the length and width of hypotympanum. The results of the analysis of the technical aspects of endoscopic surgery of the middle ear were used to propose the approach to the mastering of the skills necessary for the performance of endoscopic tympanoplasty using a sheep head as the learning aid. This approach comprises the detailed algorithm of all stages of the surgical intervention including the preparation of the working place for the surgeon, various aspects of space ergonomics in the training laboratory, and step-by-step operations on the sheep head with the description of all phases of the surgical intervention. RESULTS: The results of the present study allowed to recommend the simulation training for the mastering of ET skills with the use of the biological model in the form of the sheep's head. The specific technical peculiarities of endoscopic tympanoplasty have been adapted to the proposed simulation system. It is concluded that the system has all anatomical topographic and morphometric characteristics necessary for the development of the ET skills in the future specialists in endoscopic otosurgery.Технические аспекты эндоскопической отохирургии требуют от врача длительной и упорной подготовки. Обучение эндоскопическому доступу представляет собой непростую задачу даже для хирургов с многолетним стажем работы с бинокулярным микроскопом, что диктует актуальность внедрения симуляционных технологий для освоения рассматриваемой техники операции. На основании изученной литературы нами предложена методология обучения навыкам эндоскопической тимпанопластики (ЭТ) на симуляционной модели. Материал и методы. Морфометрический анализ структур наружного и среднего уха барана на основании компьютерной томографии (n=15). Анализ данных указанного метода лучевой диагностики позволил определить среднюю длину, горизонтальный диаметр наружного слухового прохода; вертикальный, горизонтальный размер и площадь барабанной перепонки, угол наклона барабанной перепонки к наружному слуховому проходу, объем барабанной полости, а также ширину и длину гипотимпанума. На основании анализа технических аспектов эндоскопической хирургии среднего уха предложен способ освоения навыков ЭТ на бараньей голове. Данный способ содержит подробный алгоритм всех этапов хирургического вмешательства, включая подготовку рабочего места хирурга, аспекты эргономики пространства в учебной лаборатории, а также пошаговые алгоритмы этапов операции с описанием всех этапов хирургического вмешательства. Результаты. Разработан симуляционный тренинг для освоения навыков ЭТ с использованием биологической модели - бараньей головы. Технические особенности ЭТ адаптированы к указанной симуляционной системе. Изучаемая симуляционная модель обладает необходимыми анатомо-топографическими и морфометрическими характеристиками, необходимыми для обучения навыкам эндоскопической отохирургии.

The study involved 172 patients with otitis media with effusion. All patients as a method of early diagnosis of otitis media with effusion conducted multislice computer tomography (MSCT). This made it possible to check the effectiveness of conservative treatment and timely perform surgical treatment, including sanitizing intervention on the middle ear with the erased clinical picture of acute mastoiditis, and to avoid complications. With the help of MSCT of the temporal bones with the dynamic observation of patients with high accuracy, you can confirm the full restoration of pneumatization of the middle ear cavities or identify possible recurrences of exudate accumulation. Patients who underwent surgery were randomly divided into 2 groups, depending on the duration of the laser myringotomy: on the 3В исследовании приняли участие 172 больных средним отитом с выпотом. Всем пациентам в качестве метода ранней диагностики среднего отита с выпотом проведена мультиспиральная компьютерная томография (МСКТ). Это позволило не только оценить эффективность консервативного лечения, но и своевременно провести хирургическое лечение, в том числе и санирующее вмешательство на среднем ухе при стертой клинической картине острого мастоидита, а также избежать осложнений. С помощью МСКТ височных костей при динамическом наблюдении пациентов с высокой точностью можно подтвердить полное восстановление пневматизации полостей среднего уха или выявить возможные рецидивы накопления экссудата. Пациенты, перенесшие хирургическое вмешательство, были случайным образом распределены на две группы в зависимости от срока проведения лазерной миринготомии: на 3-и сутки стационарного лечения (1-я группа) или на 7-е сутки стационарного лечения (2-я группа). Прекращение отделяемого из барабанной полости и восстановление слуха у пациентов 1-й группы происходило достоверно в более короткие сроки (р0,05). Миринготомию с помощью СО

The extent of middle ear aeration before second-stage canal wall-down (CWD) tympanoplasty was correlated with postoperative middle ear stability.To evaluate middle ear aeration before second-stage CWD tympanoplasty as a predictor of postoperative re-aeration potential and external auditory canal (EAC) stability in staged CWD tympanoplasty with soft-wall reconstruction (SWR).Middle ear aeration was evaluated before and at 1 year after the second-stage operation in patients who underwent staged CWD tympanoplasty with SWR for middle ear cholesteatoma. Based on the computed tomography (CT) findings, middle ear aeration was graded as A when the mastoid and tympanic cavities were aerated, B when only the tympanic cavity was aerated, and C in cases with no aeration in the tympanic cavity. We also examined postoperative EAC stability.Forty-one ears were included. In all, 17 of 19 ears (89.5%) with grade A aeration preoperatively maintained grade A aeration postoperatively, while 5 of 18 ears (27.8%) with grade B aeration had grade A aeration, and no ear with grade C aeration had recovered grade A aeration. All ears with grade A aeration preoperatively maintained smooth EACs. EAC retraction requiring additional treatment occurred in five ears with grade B aeration and all ears with grade C aeration.

The purpose of this study was to assess the diagnostic performance of 3T MRI after intratympanic injection of gadodiamide for delayed endolymphatic hydrops (DEH), and assess the relationship between endolymphatic hydrops (ELH) and vestibular function in patients diagnosed with DEH and confirmed by 3T MRI. Nineteen patients clinically diagnosed with DEH (11 ipsilateral DEH, 8 contralateral DEH) participated in this study. Diluted gadodiamide was administered to the bilateral tympanic cavity by injection through the tympanic membrane. At 24 hours post-injection, the ELH was evaluated by MRI. Patient vestibular functions were evaluated by caloric testing and cVEMP. ELH was observed in all patients (19/19: positive rate 100%). The distribution patterns of ELH varied between the cochlear or vestibular region. Vestibular ELH was observed in the affected ear in all ipsilateral DEH patients. In the contralateral DEH patients, however, there were individual differences in the distribution patterns of ELH. Six patients (1 ipsilateral DEH, 5 contralateral DEH) had bilateral ELH. No obvious relationships were observed between ELH and vestibular function. ELH distribution was complicated, particularly in the contralateral DEH cases. It was difficult to identify the existence of ELH by vestibular functional testing alone; therefore, 3T MRI is thought to be useful for identifying the affected ear. A significant number of cases had "bilateral" DEH, particularly among the contralateral DEH cases, indicating that we should pay careful attention to this pathology when treating DEH.

Otitis media of the left ear was diagnosed by video otoscopic examination in a 7-year-old, intact male Shih-tzu dog (weight, 5.1 kg), that also had three complex ceruminous adenomas and a Pseudomonas aeruginosa infection in the left ear canal. In such cases, total ear canal ablation is usually required. However, a complete cure was achieved in the present case without total ear canal ablation. The complex ceruminous adenomas were excised using a diode laser, and repeated cleansing of the tympanic cavity and ear canal was implemented using a video otoscope. As a result, the ear canal was closed in a U-form, and the otitis media was cured.

Objective To use cross-sectional imaging (helical computed tomography (CT)) combined with conventional anatomical dissection to define the normal anatomy of the nasal cavity and bony cavitations of the koala skull. Methods Helical CT scans of the heads of nine adult animals were obtained using a multislice scanner acquiring thin slices reconstructed in the transverse, sagittal and dorsal planes. Subsequent anatomical dissection permitted confirmation of correct identification and further delineation of bony and air-filled structures visible in axial and multiplanar reformatted CT images. Results The nasal cavity was relatively simple, with little scrolling of nasal conchae, but bony cavitations were complex and extensive. A rostral maxillary recess and ventral conchal, caudal maxillary, frontal and sphenoidal paranasal sinuses were identified and characterised. Extensive temporal bone cavitation was shown to be related to a large epitympanic recess. Conclusions The detailed anatomical data provided are applicable to future functional and comparative anatomical studies, as well as providing a preliminary atlas for clinical investigation of conditions such as cryptococcal rhinosinusitis, a condition more common in the koala than in many other species.

In this study, modelling of the human hearing is considered. Due to the nonlinearity of the middle ear, the sound transfer changes as the equilibrium position of the middle ear structure varies. For the description of the middle ear a nonlinear elastic multibody system is derived. The tympanic membrane and the air in the ear canal as well as in the tympanic cavity are considered as elastic bodies. They are first modelled using the finite element method. The large number of degrees of freedom makes a following reduction step of the acousto-structural finite element model inevitable. The second-order structure of the system matrices is preserved by applying reduction techniques based on Petrov-Galerkin projection. The nonlinearity of the tympanic membrane is included following the approach of parametric model order reduction by matrix interpolation assuming that the nonlinearity can be represented by the relative pressure between the ear canal and the tympanic cavity. Finally the static and dynamic behaviour of the simulation model is reviewed for different static pressure loads of the middle ear.

We have developed a new finite element (FE) model of human right ear, including the accurate geometry of middle ear ossicles, external ear canal, tympanic cavity, and mastoid cavity. The FE model would be suitable to study the dynamic behaviors of pathological middle ear conditions, including changes of stapedial ligament stiffness, tensor tympani ligament (TTL), and tympanic membrane (TM) stiffness and thickness. Increasing stiffness of stapedial ligament has substantial effect on stapes footplate movement, especially at low frequencies, but less effect on umbo movement. Softer TTL will result in increasing umbo and stapes footplate displacement, especially at low frequencies (f1500 Hz. As (TM) thickness was increased, the umbo displacement was reduced, especially at very low frequencies (f

Objectives: The tympanic cavity contains 3 small immovable bones, the malleus, incus and stapes. Extensive studies have been carried out on the morphometry of the ossicles. According to some scientists, in human beings the auditory ossicles reach there definitive size and shape in fetal periods and postnatal modifications are minimal, while there are certain studies which their contradict this claim. These contradictory claims prompted us to make an endeavor to find out the growth pattern of the ear ossicles and comparing the data with adults.Methods: Twenty-two fetal cadavers of either sex, ranging in gestational ages between 24-40 weeks, were collected from local hospitals and 15 adult formalin-fixed cadavers in age groups of 20-30 years were taken. For the study, the fetuses were kept in 2 Groups of 24-28 weeks and 36-40 weeks. From the data obtained, the mean, standard deviation and percentage gain from one group to another in different dimensions of various parts of each ossicle was calculated.Results: The age periods between 40 weeks (full term fetuses) and adults, revealed spurt in the growth of diameter of head of malleus (3%), width of short process of incus (2.7%), width of footplate (5.2%) and height of stapes (13%). These changes were insignificant in terms of acoustic transmission.Conclusion: It is concluded that by the end of gestation, the ear ossicles develop morphometric features comparable to adults with no appreciable changes in the post natal period. Hence, they can be used as prosthesis in adults suffering from ossicular chain malformations and can be an easy and cheap method for treatment of this type of patients.

OBJECTIVE: The aim of this study was to evaluate which factors are best predictors of hearing improvement after tympanoplasty and to evaluate best functional outcome in different forms of pathology in the tympanic cavity and mastoid in chronic otitis media. METHODS: Prospective study included 120 patients who were operated for chronic suppurative otitis media and cholesteatoma in the ENT Department University Clinic Center Banja Luka from 2006 to 2011. Multiple linear regression analysis was used to measure which factors predict better hearing improvement. MAIN OUTCOME MEASURES: A model that evaluates factors related to chronic otitis media: ossicular chain integrity, tympanic tube function, tympanic membrane perforation, type of surgery and condition of tympanic and mastoid walls was used to predict postoperative hearing improvement. Hearing outcome was measured comparing preoperative to postoperative pure-tone average (PTA) and postoperative air-bone gap (ABG). RESULTS: Out of 120 operated patients, we performed primary surgery in 106 and revision surgery in 9 cases due to recurrent cholesteatoma. We observed high correlation and statistically significant contribution of ossicular chain pathology (b=-0.310, t=-3.01, p

To determine the anatomic differences in patients of atresia by using high-resolution computed tomography (HRCT) and 3D volume rendered (VR) CT.High-resolution computed tomography (HRCT) was performed in 43 atresia patients including 34 unilateral atresia patients (n=34, 26 males, 8 females, mean age 13.82 years, range 8-19 years) and 9 bilateral atresia patients (6 males, 3 females, mean age 13.2 years, range 9-19 years). HRCT and 3D VR findings were compared with those in 43 normal ears of the unilateral atresia patients with normal PTA results (n=34, 26 males, 8 females, mean age 13.82 years, range 8-19 years) and 11 patients with sensorineural hearing loss but with no associated aplasia of the middle and inner ear (n=22, 7 males and 4 females, range 8-20.8 years, median age of 13.4 years) by using the independent one sample T test.On the HRCT images, the angle between the basic line and the tympanic segment of the facial nerve is more acute. And the area of the malleus-incus-joint or the malleus-incus-complex in the diseased ears is smaller than that in the control subjects (P0.05). The tympanic segment is shorter and the area of the tympanic cavity is smaller in the atresia group, while the diameter of the oval window is also smaller in atresia group than that in the control group (P0.05). The morphologic differences of the small ossicles and the entire length of the tympanic and mastoid segments can be depicted on a single 3D VR CT image.The facial nerve demonstrates abnormal lateral and anterior displacement in the CAA patients and the area of the Malleus-incus-joint and the tympanic cavity are significantly smaller, and the oval window is much narrower in the control group. HRCT and 3D VR CT provide valuable information about preoperative planning of patients with CAA. Measurements of all the angles and length serve as useful adjunct measurements in determining surgical candidacy.

The feasibility of virtual otoscopy (VO) imaging was evaluated in five dogs with experimentally induced otitis media, two control dogs, and two canine patients with otitis media. VO images of the tympanic cavity and ossicles were generated with commercially available software using raw computed tomography (CT) data. Eight out of 10 ears inoculated with pathogen exhibited obvious clinical signs associated with otitis externa. CT images revealed soft tissue density material occupying the tympanic bulla compatible with otitis media in three dogs with experimentally induced otitis media and two patients. No remarkable features were observed on the radiographs. Four different VO views (ear canal, tympanic bulla, eustachian tube, and ossicular chain) were created. Promontory, cochlea window, tympanic, and septum bulla as well as ossicles were easily and clearly distinguished except for the incus and stapes of the clinical patients. VO images were not more suitable than images created with conventional CT for accurately diagnosing otitis media in this study. However, it appears that VO could be more feasible for assessing the complex structure of the inner ear in dogs with fluid-filled tympanic cavities since fluid accumulation within the tympanic bulla did not affect the evaluation of bony tissue in the middle ear on VO images.

To investigate the surgical treatment and related experience of lateral skull base lesions.In a retrospective, clinical data analysis of 20 patients with lateral skull base diseases, 11 cases with temporal bone space-occupying lesions and intracranial invasion were treated by translabyrinthine surgery, mastoid cavity drainage, or transmastoid surgery to remove the lesion; two cases of cholesteatoma with destruction of tympanic cavity and tympanic sinus canopy with intracranial invasion were treated by extended radical mastoidectomy; seven cases with lateral skull base bone destruction with cerebrospinal fluid otorrhea caused by trauma and deformity were treated by translabyrinth and transmastoid repair.Eleven cases with temporal bone space occupying lesions were resected completely and were without recurrence after surgery. Two cases with intracranial infection secondary to cholesteatoma were rapidly relieved of symptoms without recurrence after radical mastoidectomy. The remaining seven cases of CSF otorrhea included two cases of Mondini malformation and five cases of temporal bone fracture. The leak was stemmed in all seven cases after surgery.Surgery is the main therapeutic option for the treatment of lateral skull base diseases. The surgical approach and the type of skull base reconstruction should be selected on an individual case-by-case basis.

The structure of the middle ear and syntopy studied in 11 human fetuses seven months of development. It was established that during this period no bottom and front wall of the tympanic cavity is not formed nadbarabannyy space. Barabanni auditory tube openings are at the bottom of the drum porozhnyny and pharyngeal openings – at the hard palate. Cave mastoid and facial nerve canal are not definitive size and the location of their different location in the newborn., Строение и синтопия среднего уха изучены у 11 плодов человека седьмого месяца внутриутробного развития. Установлено, что в этот период отсутствует нижняя и передняя стенки барабанной полости,не сформировано надбарабанное пространство. Барабанные отверстия слуховых труб расположены в нижней части барабанной полости, а глоточные отверстия находятся на уровне твердого неба. Пещера сосцевидного отростка и канал лицевого нерва не имеют дефинитивных размеров и расположение их отличается от такового у новорожденных., Будова та синтопія середнього вуха вивчені у 11 плодів людини сьомого місяця внутрішньоутробного розвитку. Встановлено, що в цей період відсутні нижня та передня стінки барабанної порожнини, не сформований надбарабанний простір. Барабанні отвори слухових труб знаходяться в нижній частині барабанної порожнини, а глоткові отвори - на рівні твердого піднебіння. Печера соскоподібного відростка та канал лицевого нерва не мають дефінітивних розмірів і розташування їх відрізняється від такого у новонароджених.

The objective of the present study was the comparative analysis of the surgical method employed for the treatment of exudative otitis medium, such as bypass surgery and laser myringotomy. The study included 125 patients suffering from the said pathology. The following two methods were used in cases of poor efficiency of conservative therapy: laser myringotomy with the use of a LUMENISc CO2-laser operated at a wavelength of 10.6 mcm with the SurgiTouch scanner and bypass of the tympanic cavity. Each of these methods was applied to treat 38 patients. It was shown that discharge from the treated tympanic cavity stopped sooner after laser myringotomy than after surgical bypass. The recovery of hearing ability according to the results of tonal threshold audiometry also took less time after laser myringotomy than after surgical bypass. The same is true with respect to the restoration of the drainage function of the Eustachian tubes. The frequency of recurrent exudate formation (in percent) in the patients undergoing laser myringotomy was significantly lower than after surgical bypass.Цель работы - сравнительный анализ хирургических методов лечения экссудативного среднего отита: шунтирования и лазерной миринготомии. Под наблюдением находились 125 больных экссудативным средним отитом. При неэффективности консервативной терапии применялись два метода хирургического лечения: лазерная миринготомия СО2-лазером с длиной волны 10,6 мкм со сканером SurgiTouch (38 пациентов) и шунтирование барабанной полости (38 пациентов). Прекращение отделяемого из барабанной полости у пациентов после лазерной миринготомии происходило в более короткие сроки, чем у пациентов, подвергшихся шунтированию барабанной полости. Восстановление слуха по данным тональной пороговой аудиометрии и восстановление дренажной функции слуховых труб у пациентов после лазерной миринготомии происходит также в более короткие сроки. Процент рецидивирования выпота в барабанной полости у пациентов после лазерной миринготомии достоверно ниже, чем у пациентов после шунтирования барабанной полости.

Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator.The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service.All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p 0.05) and average completion time for junior and senior residents (p 0.05) suggest construct validity.A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation.

Middle ear adenoma with neuroendocrine differentiation (MEA-ND), also known as carcinoid tumor of the middle ear, is an extremely rare neoplasm, especially when located within the tympanic cavity. To the best of our knowledge, this represents the first pediatric case of a MEA-ND described in Europe. Excluding the present case, only three other pediatric cases of this disease have been published globally. We report on a 15-year-old female patient who presented with conductive hearing loss of the right ear. A tympanogram was flat. Ear microscopy revealed bulging of the right posterior superior tympanic quadrant. Computed tomography depicted an opacification of the middle ear and mastoid air cells without evidence of bone erosion. Paracentesis was performed assuming a serous otitis media. Since there was no liquid found the patient underwent an atticoantrotomy and mastoidectomy as therapy for cholesteatoma. Histologic examination revealed a highly differentiated neuroendocrine tumor. Immunohistochemical evaluation showed strong positivity for synaptophysin. On the basis of these results, the patient underwent a middle ear revision surgery. After 15 months, magnetic resonance imaging and octreotide scans suggested disease recurrence, prompting a second surgical revision. The histologic examination confirmed a recurrence of only 1 mm, but postoperative imaging still showed pathological diffuse enhancement. Eight years after the initial diagnosis there has been no evidence of recurrence or metastasis. In our opinion a pathological radiological result is insufficient to identify recurrent or residual disease within the tympanic cavity.

Dehiscent internal carotid artery (ICA) in the middle ear is a rare condition, with conservative treatment primarily recommended. We report the case of a 63-year-old patient referred to the Ear, Nose, and Throat (ENT) ward for unbearable pulsatile tinnitus. Otoscopy revealed a normal right tympanic membrane, with pulsatile tinnitus but without hearing impairment. Based on imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI) of the temporal bone, as well as Doppler ultrasound of the internal carotid artery and sigmoid sinus, the diagnosis of ICA canal dehiscence into the tympanic cavity was established, thus excluding the diagnosis of aberrant ICA. Following the patient's own request, we undertook surgical correction, with the technique used described in the report. Immediately postoperatively, the pulsatile tinnitus had disappeared, with no surgical complications noted. At the 9-month follow-up, otoscopy revealed a healthy right tympanic membrane and the patient reported no remaining symptoms.

"Notohippidae" is a probably paraphyletic family of medium sized notoungulates with complete dentition and early tendency to hypsodonty. They have been recorded from early Eocene to early Miocene, being particularly diverse by the late Oligocene. Although Rhynchippus equinus Ameghino is one of the most frequent notohippids in the fossil record, there are scarce data about cranial osteology other than the classical descriptions which date back to the early last century. In this context, we describe the exceptionally preserved specimen MPEF PV 695 (based on CT scanning technique and 3D reconstruction) with the aim of improving our knowledge of the species, especially regarding auditory region (petrosal, tympanic and surrounding elements), sphenoidal and occipital complexes. Besides a modular description of the whole skull, osteological correlates identified on the basicranium are used to infer some soft-tissue elements, especially those associated with vessels that supply the head, mainly intracranially. One of the most informative elements was the petrosal bone, whose general morphology matches that expected for a toxodont. The endocranial surface, together with the surrounding parietal, basisphenoid, occipital, and squamosal, enabled us to propose the location and communication of main venous sinuses of the lateral head wall (temporal, inferior and sigmoid sinuses), whereas the tympanic aspect and the identification of a posterior carotid artery canal provided strong evidence in support of an intratympanic course of the internal carotid artery, a controversial issue among notoungulates. Regarding the arrangement of tympanic and paratympanic spaces, the preservation of the specimen allowed us to appreciate the three connected spaces that constitute a heavily pneumatized middle ear; the epitympanic sinus, the tympanic cavity itself, and the ventral expansion of the tympanic cavity through the notably inflated bullae. We hope this study stimulates further inquires and provides potentially informative data for future research involving other representatives of the order., Facultad de Ciencias Naturales y Museo

OBJECTIVE To describe a method of cochlear implantation in which the opening of the cochlea and the electrode array insertion are performed under water (underwater technique). STUDY DESIGN Retrospective patient review. SETTING Academic tertiary referral center. PATIENTS Fifteen implantations in children and adult patients with residual hearing at the frequencies 250, 500, and 1000 Hz on the unaided preoperative pure-tone audiometry were included in this study. INTERVENTION(S) Cochlear implantation with a conventional full-length electrode, in which the opening of the cochlea and the electrode array insertion are performed after the tympanic cavity was filled with body-temperature Ringer solution. MAIN OUTCOME MEASURE(S) Changes on residual hearing 6 to 8 weeks after surgery and at subsequent follow-up appointments were analyzed. Preservation of residual hearing was defined as measurable postoperative threshold at the frequencies 250, 500, and 1000 Hz. RESULTS Overall postimplant hearing preservation 6 to 8 weeks after implantation was achieved in 13 of the patients (87%). Subsequent follow-up was performed on average 15.2 months after surgery (range, 7-32) in 14 out of 15 patients. At this late postoperative evaluation preservation of hearing was recorded in nine patients (64%), whereas in the remaining five patients (36%) no residual hearing was measured. CONCLUSION The underwater technique offers a reliable nontraumatic method for electrode array insertions during cochlear implantation. The method respects the physiology of the cochlea und minimizes the pressure variations during cochlear opening and implantation.

Background The main objective of this paper is to study the mechanical influence of the tympanic cavity (TC) in the auditory system (AS). It is done for a frequency range from 0.1 to 20 kHz and the pressure source was applied in the external ear canal (EEC) entrance. Methods Numerical simulations were developed for seven different models by means of finite element model. On the basis of an EEC finite elements model, the additional elements are coupled and removed in order to evaluate the contribution of the TC. Tympanic membrane, ossicular chain, simplified cochlea and TC were modeled and simulated in four different combinations. Results Pressure, velocity, and displacement measures were obtained in AS key points in order to be compared with experimental results. Umbo and stapes transfer functions have been represented. Conclusions The main conclusion is that we find evidence that the presence of the TC in the AS introduces a second resonance in middle ear transfer functions at frequencies above 3 kHz.

El objetivo fue determinar el volumen de la cavidad timpanica (CT) en recien nacidos, informacion no encontrada en la literatura. Se realizaron escaners a traves de tomografia computadorizada (TC) y estudios histologicos en el hueso temporal; los datos se analizaron utilizando un software desarrollado en nuestra institucion. Se obtuvieron imagenes de secciones de TC, de 0,5 mm de grosor, a partir de 5 cadaveres de recien nacidos, los que fueron analizados de forma independiente por dos investigadores expertos. El margen de los cortes de TC fue delineado manualmente y la medicion del area de interes se estimo sobre imagenes ocultas. Despues, se anadieron las mediciones de area de todas las secciones para estimar el volumen total. Las concordancias entre el estudio histologico y los hallazgos de la TC se compararon en cuanto a precision, repetibilidad y confiabilidad. Se utilizaron las medidas de coeficiente de similitud de Jaccard y Dice como metrica de validacion estadistica para evaluar el desempeno del asesor en la medicion manual del volumen. Se observo una buena correlacion del evaluador con los valores medios de Dice, por encima de 0,8 indicando que es factible obtener mediciones coherentes y confiables de volumen. El protocolo propuesto ha demostrado ser preciso para calcular el volumen de la CT, y por lo tanto se puede utilizar para la planificacion prequirurgica asistida o para el diagnostico de alteraciones estructurales en la CT.

This study is to investigate the dose distribution of organs at risk (OARs) in cases of nasopharyngeal carcinoma (NPC). From July 2013 to October 2014, a prospective cohort study involving 148 patients was carried out at our center. OARs surrounding the nasopharynx were contoured on axial CT planning images in all patients. Dose-volume histograms of OARs and gross tumor volumes (GTV) were calculated. Multivariate analysis showed that radiation dose to OARs was associated with T stage and, especially, GTV. Seven OARs, including the spinal cord, eye and mandible, easily tolerated radiation doses in all patients; six OARs including the brain stem, chiasm and temporal lobe easily tolerated radiation doses in patients with a small GTV, but with difficulty when GTV was large; and other nine OARs including the parotid gland, cochlea and tympanic cavity met tolerance doses with difficulty in all patients. According to the patterns of radiation doses to OARs, it may help us to further reduce subsequent complications by improving the efficiency of plan optimization and evaluation.

The objective of this study was to improve the effectiveness of the treatment of patients with chronic otitis media with epidermization. The authors have developed a new ventilation method of the newly created tympanum with severe persistent dysfunction of the auditory tube under which the air from the external auditory canal enters the tympanic cavity in portions, bypassing the auditory tube, in which the pressure decreases. This method is applied in 22 patients with complete or partial tympanum epidermization. The article presents the options for using the developed technique, depending on the degree of preservation of sound­conducting system of the middle ear. It has been pointed out that the creation of the tympanic cavity conditions, similar to the healthy ear, provides more rapid recovery of the mucous membrane in the places without mucous membrane, thus significantly reducing the risk of recurrent imperforation of tympanic cavity.

The aim of our study was to analyze the possibility of middle ear monitoring in children to predict chronicity and recurrence of otitis media. Material and Methods: Children aged 1 to 7 years of life were monitored by screening tympanometry and screening otoscopy during 2 years. Workup also included complete audiological examination: Impedance Audiometry, Conventional Audiometry, Oto-Acoustical Emissions and Brainstem Electrical Response Audiometry and Xray examination of paranasal sinuses, bacteriologic examination, spiral CT with 3D reconstruction of tympanic cavity and mastoid process. Oto-microsurgical intervention by modified method was done in children with recurrent and chronic otitis media. Results. Pre-chronic and recurrent forms were diagnosed in 36 % and 18 % of children with respiratory pathology, in difference from healthy group, 3% and 4 % (p

Finite-element models of the intact middle ear and the diseased one with the eardrum subjected to retraction in the posterosuperior quadrant are proposed. Because the natural frequencies of the middle ear oscillating system are the principle dynamic characteristics, finite-element calculations of eigenfrequencies for both the normal middle ear and the middle ear with pathological changes of the tympanic membrane in the posterosuperior quadrant are carried out. The geometrical model of the middle ear consisting of the eardrum, malleus, incus, and stapes was obtained on basis of the tomographic data. When the eardrum has a retraction pocket, a cartilage transplant superimposed on the posterosuperior quadrant is considered as a reinforcing element. The optimal thicknesses of the cartilage transplant are defined in such a manner that the natural frequencies of the reconstructed middle ear were as close to those of the normal middle ear as possible. The obtained results can be used to predict the thickness of the cartilage transplant needed to restore the functions of the human middle ear.

The protympanum, a final common pathway between the tympanic cavity and external environment, is gaining relevance due to the ease and completeness of visualization with angled endoscopes. Two primary conformations are described, quadrangular and triangular, and new anatomic structures such as the protiniculum, subtensor recess, and protympanic spine are defined. Surgical relevance of the protympanum is described with respect to ventilation, cholesteatoma, cerebrospinal fluid leak, otic neuralgia, and surgical access to the eustachian tube.

The article describes the results of examination of patients with otosclerosis before surgery on the medial wall of the tympanic cavity with cone­beam computed tomography (CBCT). The following parameters were evelauated at the tomographic image: the width (internal and external) and the shape of the vestibule window niche, the presence or absence of the facial nerve canal and promontorium overhang, the distance from the stapes basis to the inner wall of the vestibule, the presence or absence of the round window ossification, the width of the round window. The data obtained by CBCT were compared with surgical data. Diagnostic sensitivity was 100%, specificity constituted 81%. Therefore, the cone­beam tomography can be used in the diagnostic algorithm before planning of the tympanic cavity medial wall surgery.

The homologies between the malleus, incus, and ectotympanic bones of the mammalian middle ear and the articular, quadrate, and angular bones of the tetrapod palatoquadrate, respectively, are well-established by embryonic evidence. The evolutionary question of how the implied transition occurred is less clear and, historically, there have been two general views. The first view is that the ancestral state was a reptile-like tympanic membrane behind the quadrate that activated the stapes, and that the jaw hinge bones were subsequently incorporated between tympanic membrane and stapes. The second view is that in the ancestor, low-frequency ground-borne sound was received by the lower jaw and transmitted via the hinge bones and stapes to the fenestra ovalis. The anatomy of the middle ear region of the known sequence of fossil stem-group mammals—pelycosaurs, basal therapsids, and several cynodonts—is reviewed in this chapter. As with almost all recent authors, the interpretation offers support for the second view. Within the cynodont grades, decreasing mass of the postdentary bones relative to the dentary is part of a complex of changes in the feeding mechanism but also implies increasing sensitivity to airborne sound. As long as the jaw hinge continued to perform a mechanical role in mandibular function, the bones were too massive to be receptive to higher frequency sound, and therefore an air-filled tympanic cavity and tympanic membrane were unlikely to have evolved. This latter stage awaited the origin of the new mammalian jaw hinge between the dentary and squamosal bones in mammaliaforms.

The objective of the work is to improve the efficacy of the treatment of patients with chronic otitis media with the tympanic cavity epidermization. The authors suggested the new methods of surgical treatment of these patients based on the developed valve mechanism of the tympanic cavity ventilation and formation of reliable new membrane tympanum resisting retraction and re-atresia of the newly created air cavity. The article provides a detailed analysis of the results of surgical treatment of these patients in the primary (treatment according to the newly developed techniques) and control (treatment according to the previously developed, conventional techniques) groups. The authors designed and presented an algorithm of medical rehabilitation of patients with chronic otitis media with tympanic cavity epidermisation.