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Introduction: We developed a new treatment method that combines tympanoplasty with transplantation of autologous cultured nasal mucosal epithelial cell sheets to regenerate the mucosa of patients with adhesive otitis media, which has been difficult to treat effectively. We verified whether this procedure could be performed safely and measured its therapeutic efficacy. Methods: Autologous nasal mucosal epithelial cell sheets were manufactured at a good manufacturing practice-compliant cell processing facility using autologous nasal mucosal tissue. We performed tympanoplasty and transplanted the cell sheets into the middle ear cavity in six patients with adhesive otitis media. Results: The manufactured autologous cultured epithelial cell sheets met the predetermined quality standards and were successfully transplanted safely in all cases. Computed tomography findings after cell sheet transplantation showed that aeration in the tympanic cavity was maintained or restored in five of the six patients (83.3%). Four of the six (66.7%) patients had postoperative air-bone gap within 20 dB, which is considered a postoperative success in tympanoplasty for chronic middle ear disease. Conclusions: The results of this clinical study suggest that tympanoplasty with cell sheet transplantation can be used to treat adhesive otitis media by reliably preventing re-adhesion of the tympanic membrane.

Surgical removal of tumor is the primary treatment of choice for glomus tympanicum (GT). However, because the tumor has abundant blood flow, bleeding control is crucial, and preoperative embolization may be performed. Here, we report the case of a 46-year-old female who visited our hospital with a complaint of right pulsatile tinnitus. A red pulsatile mass was found in the right tympanic cavity, and she was diagnosed with class B1 GT and subsequently underwent surgical treatment. We judged that bleeding could be controlled by intratympanic cavity manipulation alone and decided to perform transmeatal tumor resection without preoperative arterial embolization. After creating a tympanomeatal flap and performing an atticotomy, some pieces of Spongel(®) were inserted between the tumor and the tympanic wall. The Spongel(®) absorbed the blood and created a space between the tumor and tympanic wall, which allowed for the insertion of the tip of the Vesalius(®) handpiece to coagulate the tumor. The coagulation caused the tumor to shrink, thereby widening the space and allowing for further resection. Although the surgical manipulation caused bleeding, complete resection was achieved by the application of Spongel(®) and coagulation with Vesalius(®). Since the tip of the Vesalius(®) was not burned, hemostasis was successfully achieved, and the operation proceeded while maintaining a clear field of view. There was little bleeding and no postoperative complications. The patient was discharged on the sixth postoperative day. One year after surgery, pure tone audiometry showed no change in the level of bone conduction. Spongel(®) and Vesalius(®) are useful tools that allow to safely perform surgeries even in narrow spaces such as the tympanic cavity.

This article reports the technique of making a 3 dimensional model of the epitympanic folds and spaces in the middle ear. It is intended to serve as a teaching model for both undergraduate and post-graduate medical students.

Background Although many studies have suggested that air cells may play an important role in sigmoid sinus diverticulum and/or dehiscence (SSDD)-induced pulsatile tinnitus (PT), the exact effects remain unclear. This study aims to quantitatively investigate the effect of different degrees of pneumatization of temporal bone on sound transmission from the sigmoid sinus to the tympanic cavity. Methods In the clinical study, 25 patients were enrolled to measure the sound intensity and frequency of SSDD-induced PT. In the experimental study, sound inputs at different frequencies at the dehiscent sigmoid plate were measured and compared among realistic object models of different degrees of pneumatization, when sound intensity in the tympanic cavity was fixed as the level of the PT sound intensity sensed by patients. Results The sound intensity sensed by PT patients was 34.0 ± 13.0 dB SPL, which represented the sound intensity in the tympanic cavity transmitted from the dehiscent sigmoid plate. In the experimental study, when sound received in the tympanic cavity was fixed at 34 dB SPL, the mean inputs of sound intensity at the dehiscent sigmoid plate were 46.9, 46.2, 45.2, 47.1, 57, 57.4, and 74.1 dB SPL in a hypo-pneumatized model; 42.6, 43, 41.5, 43.2, 47.3, 58.2, and 78.8 dB SPL in a moderately pneumatized model; 52.6, 52.8, 48.1, 61, 64.2, 82.4, and >87.3 dB SPL in a well-pneumatized model; and 47.2, 46.2, 45.4, 49.4, 54.9, 66.6, and 77.7 dB SPL in hyper-pneumatized model, with increased sound frequencies (125-8000 Hz). The mean sound transmission distances were 41.7 mm, 45.2 mm, 47.6 mm, and 48.4 mm in successively better pneumatized models. Conclusion Sound reduces while passing through air cells and attenuation is lowest in the moderately pneumatized temporal bone, followed by the hypo- and hyper-pneumatized temporal bones, and the highest in the well-pneumatized temporal bone. Lower-frequency sound attenuation (≤1000 Hz) is less than that of higher-frequency sound (>1000 Hz).

Objectives to analyse the risk factors for developing effusion in the tympanic cavity in adults. Material and methods. We examined patients who were treated for otitis media with effusion (n=51) aged 18-70 years in the ENT department of the 11 Minsk City Clinical Hospital and the Gomel Regional Clinical Hospital during the 2018-2020 years. Results. The acute otitis media with effusion was significantly prevailing in patients of the age group 31-40 years, the chronic form predominated in people of 51-60 years old, and in all analyzed groups women dominated. In 81% of chronic inflammation of the paranasal sinuses the chronic form of otitis media with effusion prevails. Conclusion. The most frequent risk factors for the formation of the tympanic exudate were inflammatory diseases of the paranasal sinuses, pathology of the nasal cavity, predominantly female sex of working age. According to the research, it was reliably proved that smoking and rural or urban residence were not a risk factor for the formation of tympanic effusion.

Acute otitis media is one of the most common diagnoses among young children, and prematurity is the most common risk factor for its occurrence. The immaturity of the organs and systems of these children often lead to the development of pathological symptom complexes, including from the organ of hearing, which may necessitate surgical intervention. Modern microsurgical technologies signifi cantly increase the quality of operations and reduce the risk of possible complications. The surgeon’s work on these structures requires accurate knowledge of the anatomical and topographic features of the structure of the temporal bone, including in prematurely born children. The syntopy and structure of the labyrinth wall of the tympanic cavity were studied in 35 human fetuses of the seventh to tenth months of intrauterine development and 11 newborn cadavers. It has been established that the dimensions of the structures of the labyrinthine wall of the tympanic cavity in prematurely born children do not have defi nitive dimensions and their location diff ers from that in those born at term. In prematurely born children, the bone wall of the facial nerve canal is absent, in those born on time it is partially present in 18.18% of cases, the angle of passage of the facial nerve canal decreases from 33° in fetuses of the seventh month of intrauterine development to 25° in newborns. The identifi ed features are important in improving technologies and the adequacy of surgical treatment in prematurely born children., Гострий середній отит є одним із найпоширеніших діагнозів серед дітей молодшого віку і недоношеність є найпоширенішим фактором ризику його виникнення. Незрілість органів і систем цих дітей часто призводять до розвитку патологічних симптомокомплексів, у тому числі і з боку органа слуху, що може викликати необхідність хірургічного втручання. Сучасні мікроопераційні технології значно підвищують якість операцій та зменшують ризик можливих ускладнень. Робота хірурга на цих структурах вимагає точного знання анатомо- топографічних особливостей будови скроневої кістки, у тому числі й у передчасно народжених дітей. Синтопія та будова лабіринтної стінки барабанної порожнини вивчені у 35 плодів людини сьомого- десятого місяців внутрішньоутробного розвитку та 11 трупах новонароджених. Встановлено, що розміри структур лабіринтної стінки барабанної порожнини у передчасно народжених дітей не мають дефінітивних розмірів і розташування їх відрізняється від такого ж у народжених у термін. У передчасно народжених дітей відсутня кісткова стінка каналу лицевого нерва, у народжених у термін вона частково присутня у 18,18% випадків, кут проходження каналу лицевого нерва зменшується від 33° у плодів сьомого місяця внутрішньоутробного розвитку до 25° у новонароджених. Виявлені особливості мають важливе значення при удосконаленні технологій і адекватності хірургічного лікування у передчасно народжених дітей.

Limited literature exists on primary external auditory canal (EAC) cholesteatoma (EACC). Here, we focus on the clinical features of this rare disease, especially the invasive patterns of lesion progression, through a large population study and present simple and practical staging. In all, 276 patients (male 99; female 177; mean age 41.3 ± 21 years; ears 301) with primary EACC were retrospectively analyzed. Stage I indicated EACC without bony lesions, stage II indicated invasion confined within EAC, stage III indicated invasion beyond the EAC involving mastoid air cells or tympanic cavity, but within the temporal bone, and stage IV indicated invasion beyond the temporal bone. In all, 41, 219, 40, and 1 ear with Stage I, II, III, and IV lesions were found, respectively. Common clinical symptoms were hearing loss (237 ears, 78.7%), otalgia (221 ears, 73.4%), and otorrhea (85 ears, 28.2%). The mean air conduction and air-bone gaps were 45.4 ± 17.9 dB HL and 24.6 ± 15 dB HL, respectively. EACCs were found to invade in all directions of the EAC, with the inferior wall (224 ears, 74.4%) > posterior wall (207 ears, 68.8%) > anterior wall (186 ears, 61.8%) > superior wall (86 ears, 28.6%) invasion; multiwall invasions (207 ears) were common; however, inward invasions into the tympanic cavity were rare. Primary EACCs occurred mostly in women and often unilaterally invaded multiple bony walls in the lower half of the EAC. The present staging reflects the patterns and severity of lesion progression and may be beneficial in treatment planning.

Allergic fungal otomastoiditis, a rare known entity has only been published as case reports in literature. There have been 3 cases of adult and 1 case of pediatric allergic fungal otomastoiditis reported as of now. A young male had unilateral otorrhea and hearing difficulty for four years. The audiogram revealed moderate conductive hearing loss and radiograph showed complete opacification of tympanic cavity. He underwent tympano-mastoidectomy, showing polypoidal granulations and thick mucoid discharge. The histopathology was a surprise diagnosis of Allergic fungal otomastoiditis. The clinical and histopathological appearance of this entity matches allergic fungal rhinosinusitis. After extensive review of literature, we propose a working criterion for early identification of allergic fungal otomastoiditis in otolaryngology setting.

Inverted papilloma of middle ear is an extremely rare lesion of the respiratory epithelium that normally occurs in the nasal cavity and paranasal sinuses. So far less than 17 cases were described in literature. A 45-year-old patient was admitted in our Department with hearing loss, otorrhea and pulsing tinnitus on the right ear. The clinical examination showed a granulation tissue on the right eardrum. No tumor formation was seen in the nasal cavity. The MRI showed a tissue formation in the tympanic cavity with an extension in the middle cranial fossa. A mastoidectomy with antrotomy and duraplasty was performed. The histological diagnosis was inverted papilloma of the middle ear. In a second step occurred an eradication of the tumor with a subtotal petrosectomy. The etiology of the inverted papilloma of the middle ear is unknown. Our case is so far the 18Das invertierte Papillom des Mittelohrs ist eine äußerst seltene Läsion des respiratorischen Epithels, die normalerweise in der Nasenhöhle und den Nasennebenhöhlen auftritt. Bisher wurden weniger als 17 Fälle in der Literatur beschrieben. Ein 45-jähriger Patient wurde mit Hörverlust, Otorrhö und pulsierendem Tinnitus am rechten Ohr in unsere Abteilung aufgenommen. Die klinische Untersuchung ergab ein Granulationsgewebe am rechten Trommelfell. In der Nasenhöhle wurde keine Tumorbildung gefunden. Die MRT zeigte eine Gewebebildung in der Paukenhöhle mit einer Verlängerung in der mittleren Schädelgrube. Eine Mastoidektomie mit Antrotomie und Duraplastik wurde durchgeführt. Die histologische Diagnose lautete invertiertes Papillom des Mittelohrs. In einem zweiten Schritt erfolgte eine komplette Exstirpation des Tumors mit einer subtotalen Petrosektomie. Die Ätiologie des invertierten Papilloms des Mittelohrs ist nicht bekannt. Unser Fall ist bisher der 18. beschriebene Fall.Unsere Erfahrung hat gezeigt, dass die Ausrottung des Tumors mit einer subtotalen Petrosektomie als sinnvollem Eingriff resultierte. Eine langfristige Nachsorge wird empfohlen, um ein mögliches Wiederauftreten oder eine maligne Transformation festzustellen.

Several risk factors were studied in endoscopic type I. tympanoplasty, however, an easy-to-use risk stratification model is still missing. Retrospective chart review, focusing on individual risk factors and middle ear risk index (MERI). Patients who underwent endoscopic type I. tympanoplasty were included. Closed tympanic cavity was succesfully created in 88.1% of the 42 cases, the overall 21,5 dB air–bone gap (ABG) was reduced by 9,8 dB. The average MERI score of the patients was 2.1 ± 1.5. 78.6% of the patients were categorised into the mild, while 21.4% into the moderate risk group. The perforation was considered small in 81.0% of the cases, while large in 19.0%. The size of the perforation and the preoperative ABG, but not the MERI status were the only single predictors of success. Using a risk stratification model that is based on the size of the perforation, the preoperative ABG and MERI status, patients could be referred into two distinct groups of risk: the majority expecting excellent outcomes with maximum one risk factor present, and patients with deteriorated rate of success when having two or three risk factors. Endoscopic type I. tympanoplasty with underlay perichondrium graft can be performed with good chance of success. However, if more than one risk factors are present, the chance of residual perforation becomes great. In addition to the established risk factors, our results point out that despite its strong correlation with perforation size, ABG may have a predictive role.

The lateral position of the sigmoid sinus is a significant indentation of its sulcus into the lateral wall of the skull, the sigmoid sinus is located lateral to the antrum. This anomaly is rare, occurs in 5–10%. Computerized tomography of temporal bones is performed for all patients with chronic middle ear disease. CT of the temporal bones visualizes in detail the anatomy of the temporal bone. Preoperative diagnosis of lateral position of the sigmoid sinus is very important and determines the choice of a surgical approach to the middle ear during surgery. Clinical observation of a child (14 years) with cholesteatoma of the middle ear is presented in this article. CT tomograms visualized lateral position of the sigmoid sinus. However, the lateral position of the sigmoid sinus was not taken into account when choosing the surgical approach. A transcortical approach to the middle ear was chosen in this clinical observation. Therefore, there was the inevitable and unreasonable denudation of the sigmoid sinus, the difficulty in performing an operation due to the risk of injury. In the reoperation, surgical approach to the middle ear was performed through the tympanic cavity. This avoided dangerous contact with the sigmoid sinus and effectively remove cholesteatoma.

Objectives: Tympanic cavity (TC) is an anatomically challenging region for the diagnosis of lesions located inside it. Radiological diagnosis and demonstration of the anatomic localization of sporadic lesions such as vascular malformations and meningocele are essential for the prevention of complications that may occur during operation and recurrent unnecessary interventions. The aim of the present study was to demonstrate the radiological appearance of the vascular variations and the post-traumatic soft tissue lesions which are rarely encountered in TC. Methods: A total of 3525 temporal multi-slice computed tomography (MSCT) images were evaluated between 2010–2018. Twelve cases with non-inflamatory and non-neoplastic soft tissue lesions in TC were detected and 2 with meningocele were included in the study. Results: Of the 12 cases, 6 were males and 6 were females. The mean age of the patients was 26.16 years. Four cases had an aberrant internal carotid artery (ICA), being bilateral in 2 cases and right sided in the remaining 2 cases. Six cases had dehiscent mega jugular bulb (DMJB); and 2 cases had post-traumatic meningocele. Conclusion: Vascular malformations and meningoceles are rarely observed in TC. They may present nonspecific clinical signs and symptoms; however, they should be evaluated with MSCT and MRI before the surgical interventions regarding the middle ear to prevent possible complications.

OBJECTIVE The aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty. METHODS We conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome. RESULTS At one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities. CONCLUSION Our results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.