Temporal bone trauma effects on auditory anatomical structures in mastoid obliteration.

PURPOSE: The risk of temporal bone fractures in head trauma is not negligible, as injuries also depend on the resistance and integrity of head structures. The capacity of mastoid cells to absorb part of the impact kinetic energy of the temporal bone is diminished after open cavity mastoidectomy, even if the surgical procedure is followed by mastoid obliteration. The aim of our study was to evaluate the severity of lesions in auditory anatomical structures after a lateral impact on cadaveric temporal bones in which open cavity mastoidectomy followed by mastoid obliteration was performed, compared to cadaveric temporal bones with preserved mastoids. METHODS: The study was carried out on 20 cadaveric temporal bones, which were randomly assigned to two groups. In the study group, open cavity mastoidectomy followed by mastoid obliteration with heterologous materials was performed. All temporal bones were impacted laterally under the same conditions. Temporal bone fractures were evaluated by CT scan. RESULTS: External auditory canal fractures were six times more seen in the study group. Tympanic bone fractures were present in 80% of the samples in the study group and 10% in the control group (p = .005). Middle ear fractures were found in 70% of the samples in the study group and 10% in the control group (p = .02). Otic capsule violating fractures of the temporal bone were present only in the study group. CONCLUSIONS: Mastoid obliteration with heterologous materials after open cavity mastoidectomy increases the risk of fracture, with the involvement of auditory anatomical structures.

Maxillofacial trauma patterns associated with external auditory canal fractures: Cone beam computed tomography analysis.

BACKGROUND/AIMS: There is a paucity of literature on external auditory canal (EAC) fractures secondary to maxillofacial trauma, with most of the literature on EAC fractures consisting of isolated case reports. To the authors' best knowledge, this is the first study to use cone beam computed tomography to evaluate the EAC region. The aim of this study was to assess the prevalence of external auditory canal (EAC) fracture following maxillofacial trauma and to evaluate the association between EAC fracture and other maxillofacial fractures and the region of trauma. MATERIALS AND METHODS: One hundred patients were prospectively evaluated over 6 months from February to August 2016. The patients were referred for CBCT regarding temporomandibular joint or condylar fractures following maxillofacial trauma. Two observers (both experienced radiologists) assessed the EAC and associated fractures in the maxillofacial region. RESULTS: External auditory canal (EAC) fracture was confirmed in 32% of the patients. Of the EAC fractures, 68.75% and 31.25% were associated with mandibular fractures and non-mandibular fractures, respectively. Of the EAC fractures, 68.75% were single fractures and 31.25% of patients had multiple comminuted fractures. Significant association was observed on cross-tabulation of the fractured region and region of trauma with the presence of EAC fracture using chi-square test. CONCLUSION: External auditory canal (EAC) fracture is associated with maxillofacial fractures with increased incidence in mandibular fractures compared to non-mandibular fractures.

What health professionals at the Jos University Teaching Hospital insert in their ears.

OBJECTIVE: The aim of this study is to determine if health professionals in our hospital insert objects in their ears and the complications which follow. METHODOLOGY: In this prospective cross-sectional study, validated questionnaires were filled by health professionals working in our Teaching Hospital and analyzed. RESULTS: One hundred and forty one questionnaires were analyzed involving subjects aged 25 to 59 years with a mean of 42 years (SD = +/- 12.5). There were 94 males and 47 females with a male to female ratio of 2:1. Thirty four (24.1%) nurses participated in the study followed by Resident doctors (n = 22, 15.6%) and Intern doctors (n = 20, 14.2%). One hundred and twenty nine (91.5%) individuals 'clean' their ears with majority of them (n = 48, 37.2%) doing so occasionally. Multiple objects were inserted into the ears by 32 (24.0%) subjects and single objects by 98 (76%). The commonest object inserted into the ears to effect 'cleaning' was cotton buds in 115 cases. Twelve (9.3%) subjects recorded ear injuries in the process. Seven (53.3%) subjects with injuries inserted objects into their ears daily. Seven subjects recorded injuries with the use of match sticks. Sixty three (44.7%) subjects had accumulation of cerumen. Cotton buds (n = 29) were the commonest method for cerumen removal. Complications recorded from the removal of cerumen were otalgia (n = 2) and vertigo (n = 1). CONCLUSION: Health professionals in our centre have a practice of inserting various potentially dangerous objects into their ears.

Dislocation of stapes with footplate fracture caused by indirect trauma.

We report the first case of isolated stapedial dislocation caused by indirect head trauma, and present imaging and surgical findings in the case of a 25-year-old woman who suffered hearing loss and dizziness after head trauma caused by a traffic accident. The pure tone average was 60 dB, with an air-bone gap of 50 dB. The stapedial reflex was positive with the probe on the affected ear. Computed tomography scans revealed a longitudinal fracture of the temporal bone and a dislocated stapedial superstructure in the tympanic cavity, adhering to the tympanic membrane. During surgery, it was found that the stapes was broken at the base of the posterior crus and at the anterior one third of the footplate and that the stapedial superstructure was dislocated outward and downward, with the anterior one third of the footplate adhering to the tympanic membrane. The stapedial tendon was connected to the superstructure. Ossicular chain reconstruction was performed with success. In the present case, two mechanisms may have acted together: 1) an increase in perilymphatic pressure that caused the footplate to fracture, and 2) a distorting force that broke the posterior crus, disconnecting the incudostapedial joint, and finally dislocating the stapedial superstructure together with the anterior part of the footplate.

Computer simulation study of the penetration of pulsed 30, 60 and 90 GHz radiation into the human ear.

There is increasing interest in applications which use the 30 to 90 GHz frequency range, including automotive radar, 5 G cellular networks and wireless local area links. This study investigated pulsed 30-90 GHz radiation penetration into the human ear canal and tympanic membrane using computational phantoms. Modelling involved 100 ps and 20 ps pulsed excitation at three angles: direct (orthogonal), 30° anterior, and 45° superior to the ear canal. The incident power flux density (PD) estimation was normalised to the International Commission on Non-Ionizing Radiation Protection (1998) standard for general population exposure of 10 Wm-2 and occupational exposure of 50 Wm-2. The PD, specific absorption rate (SAR) and temperature rise within the tympanic membrane was highly dependent on the incident angle of the radiation and frequency. Using a 30 GHz pulse directed orthogonally into the ear canal, the PD in the tympanic membrane was 0.2% of the original maximal signal intensity. The corresponding PD at 90 GHz was 13.8%. A temperature rise of 0.032° C (+20%, -50%) was noted within the tympanic membrane using the equivalent of an occupational standard exposure at 90 GHz. The central area of the tympanic membrane is exposed in a preferential way and local effects on small regions cannot be excluded. The authors strongly advocate further research into the effects of radiation above 60 GHz on the structures of the ear to assist the process of setting standards.

Clinical Characteristics of External Auditory Canal Foreign Bodies in Children and Adolescents.

OBJECTIVES: Foreign bodies (FBs) in external auditory canal (EAC) can occur at any age but are especially common in children and adolescents. The aims of the study were to evaluate the clinical characteristics of EAC FBs in children and adolescents and to discuss their proper management. METHODS: A retrospective medical chart review was performed on patients who were treated for EAC FBs in a tertiary referral center from January 2007 to December 2017. We investigated the parameters of age, sex, type of FB, sedation method, complications, and removal strategy. RESULTS: Of 284 patients, 176 (62.0%) were male. Peak incidences were noted at the ages of 3 to 6 years and 17 to 18 years. The frequently observed FBs were insects, followed by air-gun pellets, cotton balls, marbles, and earrings. Forty-one (14.4%) EAC FBs were removed with the naked eye, while 243 (85.6%) were removed under microscope in the otolaryngology department. Of these patients, 23 (9.5%) were administered sedatives and 1 (4.1%) needed general anesthesia. During or after the removal procedure, 4 (15.5%) patients had complications of EAC abrasion or laceration (42, 14.8%), and tympanic membrane perforation (2, 0.7%). CONCLUSIONS: External auditory canal FB showed a distinct characteristic of incidence regarding age, related to removal strategies. Characteristics of FB must be considered for safe removal.

A guide to managing disorders of the ear pinna and canal.

This review will help you troubleshoot everything from infections and foreign bodies to trauma and neoplasm.

Separation of the auricular and annular ear cartilages: surgical repair technique and clinical use in dogs and cats.

OBJECTIVE: To report a surgical technique for primary repair of separation of the annular and auricular cartilages of the ear and long-term outcome. STUDY DESIGN: Case series. ANIMALS: Cats (3) and dogs (2) with ear canal separation. METHODS: Medical records (1998-2007) of dogs and cats with ear canal separation were reviewed. Long-term outcome was obtained by telephone interview of owners or referring veterinarians. RESULTS: Three cats and 1 dog had ear canal separation after being hit by a car; there was no history of trauma in 1 dog. Successful repair was achieved by a caudal approach to the ear canal, identifying and debriding separated cartilage edges and using primary repair. A patent ear canal was confirmed in all animals by otoscopy 4-12 weeks later and by ear canalography in 3 animals. Long-term outcome was excellent with no reported complications 10-90 months later (median 24 months). CONCLUSIONS: Both acute and chronic separation between the annular and auricular cartilages, in the absence of middle ear disease, can be successfully treated using primary repair via a caudal approach to the ear canal, with excellent long-term outcome. CLINICAL RELEVANCE: Primary repair should be considered in animals with separation of the annular and auricular cartilages.

[Direct hearing aid provision by ENT specialists: Recommendations for prevention and treatment of complications after taking ear impressions]. / HNO-ärztliche Hörgeräte-Direktversorgung: Empfehlungen zur Vermeidung und Behandlung von Komplikationen bei der Ohrabdrucknahme.

In times of budgeting, rising costs and monetary losses, an increasing number of ENT specialists considers the hearing system sector due to the distinct undersupply and the expected demographic development to be a market of the future and appropriate to enlarge their field of competence. Exact prevalence of direct hearing aid provision by German otorhinolaryngologists as well as its complication rate are not well-known. Retrospectively, all patients were evaluated who presented at our department with complications in the context of outpatient direct hearing aid supply within the last 3 years. Inappropriate fitting contains the danger of malformed or displaced ear impressions with various injury patterns comprising the external auditory canal, tympanic membrane and ossicular chain. Practical advices for prevention of complications include the accurate modeling and placement of sufficient impression pads behind the second bend of the auditory canal, using an adequate type of impression material as well as performing the correct application procedures. Recommendations for diagnostic patterns and treatment of complications after taking ear impressions are presented, the differences between German "traditional" and "direct" hearing aid provision are critically discussed.

Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. / Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Intracochlear pressure in response to high intensity, low frequency sounds in chinchilla.

Exposure to high intensity (blast) sounds can result in both conductive and sensorineural damage to hearing. This includes rupture of the tympanic membrane and dislocation of the middle ear ossicles, as well as damage to the inner and outer hair cells in the cochlea. A clearer understanding of how the hearing system responds to blast could help us better prevent auditory trauma, and support those who have been exposed to such sounds. Chinchillas are often used in studies of hearing due to the similarity between the chinchilla and human audiograms. The suitability of their use in research on auditory trauma from blast noise will depend on the extent to which cochlear pressures generated in chinchillas compare to those in humans. In order to gain a more detailed understanding of the response of the ear to high intensity sounds, a custom built sound concentrating horn was used to expose chinchilla cadaveric ears to a series of single frequency tones between 10 and 1280 Hz, with varying intensities from 90 to 194 dB SPL while intracochlear pressures were measured simultaneously in the scala vestibuli and scala tympani. These results were then compared to similar, previously published data from human cadavers. In both human and chinchillas, intracochlear pressures increased with applied sound pressure up to about 120 dB SPL, but began to saturate at higher intensities. The exact saturation point and the saturation pressures showed a strong frequency dependence. Intracochlear pressure magnitudes in chinchillas show some similarities with those measured in humans, but also significant differences, particularly at very high intensity levels such as those found in a blast. These differences should be taken into account when conducting blast studies in chinchillas.

Krazy Glue® in the ear: A case report of child abuse.

Krazy Glue® or cyanoacrylate glue is an acrylic resin that polymerizes in less than a minute when in contact with moisture or water. We present a case of a one month old referred to our tertiary pediatric otolaryngology clinic from an outside emergency department with a history of application of cyanoacrylate glue in the external ear canals. This report presents the management of this case along with the medical and legal outcomes surrounding this case of child abuse.

A rare case of synovial otorrhea of iatrogenic nature in dentistry.

The authors describe a unique case of left synovial otorrhea in a masticatory phase, occurring in a 64-year-old patient after a long dental sitting. The otoscopic examination and the transverse CT of the ear revealed the fracture of the anterior wall of left external auditory canal and the presence of a small bone fragment on the external side of the glenoid fossa. This situation, at present, has been judged inoperable by otologists due to the close relationship between this area and the head of the left condyle, probably responsible for the fracture. The therapy used was based on the use of a masticatory bite plate, with the aim of increasing the vertical dimension of the jaws during mastication and, so, to keep the condyle in a forward position. The result obtained was the decrease and then the halting of the liquid exit in the auricle, through an increase of the bite plate height determined by the ex iuvantibus method. This temporary therapy could bring about a spontaneous healing of the fracture, thanks to the masticatory increase of the bite plate; but if this is not possible, a fixed prosthetic solution should then be provided for the patient. Research into the literature revealed no similar observations.

[Acute ear trauma caused by failure of mobile phone/cellular phone]. / Ostry uraz akustyczny i termiczny ucha spowodowany awaria telefonu komórkowego.

The case of acute acoustic and burn ear trauma caused by mobile phone failure is presented. A woman aged 24 after dialling a phone number and putting a phone into the ear heard a sound of high frequency and intensity. At the same time she felt a pain and heat and there was also a smoke from the phone. With otoscopic examination a burn of external acoustic duct (I0) and sensitive hearing loss (examination made with tuning forks) were stated. The patient did not agree to stay in hospital and she was administered prednizone, trimetazidin and xantylol nicotinate. Audiometric examination, which was made on another day, showed hearing loss of 30 dB for frequency 4000Hz. After 2 days she started to hear a sound like a sea noise in her right ear. In the control examination, made 2 weeks after injury, no abnormalities in audiogram were stated but the patient steal heard ear noise. She continued to take trimetazidin and betahistin and after one month all symptoms of ear injury relieved. Patient is still under control of otolaryngologist. Unfortunately our efforts to explain the cause of such accident from phone producer were ineffective. Described case proves that mobile phone failure can be a cause of acute ear injury.

Spontaneous temporomandibular joint herniation into the external auditory canal: a case report and review of the literature.

OBJECTIVES: Case report of a man presenting with spontaneous temporomandibular joint (TMJ) herniation into the external auditory canal (EAC). STUDY DESIGN: Case report and literature review. METHODS: A case report of a patient with spontaneous TMJ herniation into the EAC is presented. RESULTS: The patient was a 41-year-old man complaining of tinnitus in his right ear. Examination revealed that the anterior wall of the bony EAC moved backward when the patient's mouth was closed and forward when opened, causing the resultant discomfort. In this case, surgery was performed, resulting in a good outcome with no complications. Thirteen other cases of spontaneous TMJ herniation into the EAC were found in the literature. CONCLUSION: Few cases of spontaneous TMJ herniation into the EAC have been reported; however, if surgical treatment is desired, we should comply with the patient's request.